Current approach to branchial remnants in the neck

Abstract

Congenital branchial fistulas and cysts are an interesting subject in cervical pathology. There are congenital malformations with late expression in young adults that require correct diagnosis and appropriate treatment. We review essential notions of cervical embryology to understand the mechanism of occurrence of these malformations and their clinical expression. The most common cases present vestiges from the second branchial arch, with the appearance of a cystic tumor or a fistulous orifice on the anterior edge of the sternocleidomastoid muscle, at the level of the hyoid bone. Performant imagery is mandatory for appropriate diagnosis, so we recommend a cervical computed tomography (CT) scan or cervical magnetic resonance imaging (MRI) to evaluate the relations with great vessels of the neck or other lesions. The treatment implies complete surgical excision because otherwise there is a high risk of recurrence of the lesion. The differential diagnosis includes cystic lymphangioma, dermoid cyst, tuberculous adenopathy, cystic hygroma, lateral cervical cystic metastases. Histological examination is mandatory for a definite diagnosis. Also, there is a small percentage of malignancy of these malformations, but it is very important to check that all the histological diagnostic criteria for a primary branchiogenic carcinoma are accomplished. Therefore, although it is a benign cystic cervical pathology, the diagnosis and treatment must be made very accurately for a complete cure, and this review aims to summarize the current approach to branchial remnants of the neck.

Frequency of MRI Low Signal Intensity in the Buccal Fat of Fetuses and Speculation as to What It May Reflect

“…Additionally, the differential diagnoses are unlikely to be bilateral. Branchio-oto syndrome (BOS) or branchio-oto-renal syndrome (BORS) with hearing impairment and abnormal phenotype of ears is accompanied by renal malformation and branchial cleft anomalies cysts, which also needs to be considered for bilateral cystic lesions with high T1 signal affecting the face, and evaluation of the ears and kidneys would be useful-none of our patients had features of this syndrome [29].…”

Management of Capillary Hemangioma of the Sphenoid Sinus

“…Sometimes the histological diagnosis of capillary hemangioma can be difficult due to the endothelial proliferation pattern that resembles malignant lesions and ulceration that corresponds to granulation tissue [ 14 ]. Differential diagnosis can be made with nasal angiofibroma (when the patient is an adolescent male juvenile, angiofibroma can be taken into account), angiomatous polyp of the nose and sinuses, polypoid granulation tissue, inverted papilloma, lymphangioma, hemangiolymphangioma, glomangiopericytoma, or angiosarcoma [ 9 , 18 , 19 , 21 ]. Angiofibromas contain large-diameter blood vessels and stellate fibroblasts, which differ from the small-diameter vessels encountered in capillary hemangiomas [ 19 ].…”

“…Angiofibromas contain large-diameter blood vessels and stellate fibroblasts, which differ from the small-diameter vessels encountered in capillary hemangiomas [ 19 ]. Hemangiolymphangiomas are rare, lymph-containing vascular tumors characterized by multiple lymph vessels surrounded by loose fibrovascular stroma [ 2 , 21 ]. Glomangiopericytomas present more cells and less endothelial lining than capillary hemangiomas [ 19 ].…”

Branchiogenic cyst ‒ a rare finding in vascular surgery

“…Even though there are strict criteria, the diagnosis of this entity remains controversial (10,14). Also, there is a small percentage of malignancy of these malformations, but it is very important to check whether all the histological diagnostic criteria for a primary branchiogenic carcinoma are accomplished (11,12,13,18). Histopathological fi ndings suggested the diagnosis of lymph node infi ltration by squamous cell carcinoma of an unknown primary site, but the differential diagnosis also included branchiogenic carcinoma arising in a branchial cleft cyst (9,13,15,19).…”

“…The preoperative diagnosis is based on clinical and radiological fi ndings, which are also important for accurate determination of spatial characteristics of the lesion. Ultrasonography is the fi rst-line imaging method of choice to defi ne the benign, cystic nature of the lesion (1,11,12,18).…”