Two cases of nasopharyngeal branchial cyst

Nasopharyngeal Branchial Cleft Cyst: A Rare Case Report and Literature Review

Branchial cleft cysts are birth defects that happen when the first through fourth pharyngeal clefts do not close properly and most of these cysts develop from the second cleft. Second branchial cleft cysts are almost always in the neck, so it is rare for them to present in the nasopharynx. We report an extremely rare case of a branchial cleft cyst that is located in an unusual site in the nasopharynx in a 36-year-old male with no prior medical history. Computed tomography scan findings showed non-enhancing thickening of the right side mucosal-pharyngeal space, obliterating the fossa of Rosenmuller with no invasion or erosion. The patient was admitted for nasopharyngeal mass excision, and the mass was sent for histopathology. When a cystic lesion is noted in the lateral nasopharynx, branchial cleft cysts should be on the list of possible diagnoses. Surgery is primarily the treatment. The marsupialization approach is a simple way to treat nasopharyngeal branchial cleft cysts as it is safe and has limited complications.

Nasopharyngeal cysts

INTRODUCTION

Nasopharyngeal cysts are uncommon, and are mostly asymptomatic. However, these lesions are infrequently found during routine endoscopies and imaging studies. In even more rare cases, they may be the source for unexplained sinonasal symptoms, such as CSF rhinorrhea, visual disturbances and nasal obstruction.

PURPOSE OF REVIEW

This presentation systematically reviews the different nasopharyngeal cysts encountered in children, emphasizing the current knowledge on pathophysiology, recent advances in molecular biology and prenatal diagnosis, clinical presentation, imaging and treatment options.

SUMMARY

With the advent of flexible and rigid fiber-optic technology and modern imaging techniques, and in particularly prenatal diagnostic techniques, nasopharyngeal cysts recognition is more common than previous times and requires an appropriate consideration. Familiarity with these lesions is essential for the pediatric otolaryngologist.

Second branchial cyst in the parapharyngealspace: a case report

OBJECTIVE

We report the clinical findings and management of a large retro- and parapharyngeal branchial cyst in a 54-year-old man whose only complaint was a 12-month history of snoring.

METHOD

Case report and a review of the world literature concerning parapharyngeal cysts are presented.

RESULTS

On computed tomography (CT) images, a well-marginated cystic mass was observed in the left retro- and parapharyngeal spaces, with displacement of the left internal and common carotid arteries. The cyst contained thick, sterile, yellowish pus, without malignant cells. We performed a transoral resection without any surgical complications. No recurrence was observed 2 years later.

CONCLUSION

Parapharyngeal branchial cysts are rare and often paucisymptomatic. The transoral approach can provide good exposure allowing complete resection without significant post-operative complications or cervical scarring.

Conservative surgical treatment of pharyngeal branchial cyst

The parapharyngeal presentation of a branchial cleft cyst of the second arch is extremely uncommon. The treatment considered to be most effective is total extirpation via a transcervical approach, but this is not without its complications. A case is described here of a patient who requested conservative treatment. Thus, a transoral exeresis of the oropharyngeal wall of the cyst was carried out, the cyst was drained, and its borders were marsupialized to the pharyngeal wall. Postoperative evolution was towards obliteration of the tract, as should have occurred in the embryonal period.

Imaging of nasopharyngeal cysts and bursae

Cysts and bursae of the nasopharynx are uncommon and seldom symptomatic when compared with malignant tumors of this region. However, it is noteworthy that in the presence of symptoms, a good knowledge of their radiological appearance is useful to establish the correct diagnosis. Cysts of Rathke's pouch, pharyngeal bursa of Luschka, Tornwaldt's cysts, retentional cysts of the seromucinous glands, oncocytic cysts, intra-adenoid cysts, branchial cysts, prevertebral or retropharyngeal abscess and pseudocysts of the nasopharynx will be discussed in this paper.

[Cyst of the parapharyngeal space arising from the branchial arches]

OBJECTIVES

We describe a rare case of parapharyngeal space cyst arising from the branchial arches.

CASE REPORT

We report the clinical and radiological (CT and MRI) findings. Surgical resection was performed via a transcervical approach.

CONCLUSION

Branchial cysts arising from the second pouch are the most common benign neck tumors. A parapharyngeal location (type IV in Proctor's classification) is very rare, and only 24 cases have been reported. Based on our observations in this case and a review of the literature, we discuss the differential diagnoses and treatment options.

[Pharyngeal branchial cyst: description of one clinical case]

Brachial cysts are abnormalities in the development of the branchial apparatus, being the more common ones those of the second arch. Cysts localized in the pharyngeal wall (Bailey's type IV) are extremely rare; therefore its differential diagnosis should include all benign and malignant lesions that can be found in the pharyngeal wall. Treatment is the total excision of the cyst through per oral or external cervical approach in order to avoid recurrences.

A New Case of a Branchial Cyst of the Parapharyngeal Space

Branchial cysts in the parapharyngeal space are rare. Until now, only 23 such cases have been reported in the literature. In this article, we report a new case in a 65-year-old man. Information gained from the clinical examination, fiberoscopy, and computed tomography revealed that the cyst was obstructing the oropharynx and filling the parapharyngeal and retropharyngeal spaces on the right. The mass was excised via a transcervical approach without any complications. We also review the literature on this condition.

Nasopharyngeal Cyst of Branchiogenic Origin: Report of a Case and Review of the Literature

To date, only 22 cases of nasopharyngeal cyst of branchiogenic origin have been reported in the literature. In this article, we report a new case in a 35-year-old woman. We also present a review of the literature and a discussion of the sites of origin, histopathology, and treatment modalities.

Aberrant second branchial cleft fistula

Second branchial cleft cysts and sinuses rarely present diagnostic problems to the pediatric otolaryngologist as their course is usually predictable based on consistent embryologic development. However, we evaluated two fistula tracts that did not fit the classic description of second branchial tract fistulas. Upon radiographic and intraoperative evaluation, their eventual course ending in the tonsillar fossa was identified. Realizing the potential for aberrancy and using preoperative radiographic evaluation will assist the surgeon in the excision of these developmental anomalies with little risk to underlying neurovascular structures.

Pharyngeal branchial cyst: magnetic resonance findings

An unusual case of pharyngeal cyst in a 25-year-old man studied by Magnetic Resonance (MR) is described. Anatomic location and pathological findings indicated the second branchial pouch origin.

Nodal inclusion cysts of the parotid gland and parapharyngeal space: a discussion of lymphoepithelial, AIDS-related parotid, and branchial cysts, cystic Warthin's tumors, and cysts in Sjögren's syndrome

The purpose of this report is to examine the computed tomography scans, magnetic resonance images, and pathologic findings in 44 patients, 42 of whom had inclusion-type cysts of the parotid and parapharyngeal space of varying etiologies. Two additional cases of cystic changes in the benign lymphoepithelial lesion (BLEL) of Sjögren's syndrome are highlighted here, since they had unusually large cystic components mimicking acquired immunodeficiency syndrome-related parotid cysts (ARPCs). A retrospective examination identified 18 ARPCs, 3 lymphoepithelial cysts (LECs), 13 cystic Warthin's tumors, 8 branchial cysts, and 2 cases of cysts in patients with Sjögren's syndrome (BLEL), all of whom had imaging studies and pathologic confirmation. There were 30 men and 14 women with an age range of 25 to 72 years (median, 46.82 years). Any similarities in the imaging appearances were noted, as were any differences in pathologic detail. On imaging, only the cystic Warthin's tumors had any focal wall nodularity; the other cysts had smooth walls. When multiple parotid cysts were present, the distinguishing feature between ARPCs and cysts in BLEL (and some cystic Warthin's tumors) was the presence of diffuse cervical adenopathy in patients with ARPCs. Imaging usually could not differentiate between a solitary parotid LEC, a branchial cyst, and some cystic Warthin's tumors. Extraparotid lesions were either branchial cysts or cystic Warthin's tumors. Physicians should be aware of the variety of different inclusion-type cysts that may occur in the parotid gland and parapharyngeal space, all of which may have similar imaging appearances. Although imaging clearly identifies these cysts and may suggest a specific diagnosis, it must always be remembered that the precise diagnosis remains in the province of the pathologist.

Branchial cyst of the nasopharynx: resection via the endonasal approach

We present a rare branchial cyst of the nasopharynx in a 57-year-old man. The cyst was located at the higher level between the roof and the left lateral band of the nasopharynx, and was removed by the endonasal approach following a preparatory septoplasty. While several cases of nasopharyngeal cysts have previously been reported, this appears to be the first case of the resection of such a cyst via the endonasal approach, and is a useful, and potentially less injurious, alternative to the transpalatal approach.