Branchial Cleft Cyst Workup

Author: Chih-Ho Hong, MD, FRCPC; Chief Editor: Dirk M Elston, MD more...

Updated: Jul 14, 2010

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
Histologic Findings
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Laboratory Studies

No specific laboratory investigations need to be obtained in the workup of a branchial cleft cyst.

Imaging Studies

A sinogram may be obtained. If a sinus tract exists, radiopaque dye can be injected to delineate the course and to examine the size of the cyst.

Ultrasonography helps to delineate the cystic nature of these lesions.^[7]

A contrast-enhanced CT scan shows a cystic and enhancing mass in the neck. It may aid preoperative planning and identify compromise of local structures.

MRI allows for finer resolution during preoperative planning. The wall may be enhancing on gadolinium scans.^[7]

Other Tests

No other investigations are needed beyond routine preoperative workup.

Procedures

Fine-needle aspiration may be helpful to distinguish branchial cleft cysts from malignant neck masses.^[8]Fine-needle aspiration and culture may help guide antibiotic therapy for infected cysts.

Histologic Findings

Most branchial cleft cysts are lined with stratified squamous epithelium with keratinous debris within the cyst. In a small number, the cyst is lined with respiratory (ciliated columnar) epithelium. Lymphoid tissue is often present outside the epithelial lining. Germinal center formation may be seen in the lymphoid component, but true lymph node architecture is not seen. In infected or ruptured lesions, inflammatory cells are seen within the cyst cavity or the surrounding stroma.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Chih-Ho Hong, MD, FRCPC Clinical Assistant Professor, Department of Dermatology and Skin Science, University of British Columbia, Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Crawford, MD, FRCPC Head of Dermatology, Clinical Professor, Department of Medicine, Divisions of Pathology and Dermatology, University of British Columbia

Richard Crawford, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Pacific Dermatologic Association, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jean Paul Ortonne, MD Chair, Department of Dermatology, Professor, Hospital L'Archet, Nice University, France

Jean Paul Ortonne, MD is a member of the following medical societies: American Academy of Dermatology and American Dermatological Association

Disclosure: Nothing to disclose.

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

Wagner AM, Hansen RC. Neonatal skin and skin disorders. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. Vol 1. 2^nd ed. New York, NY: Churchill Livingston; 1995:291-3.
Doi O, Hutson JM, Myers NA, McKelvie PA. Branchial remnants: a review of 58 cases. J Pediatr Surg. Sep 1988;23(9):789-92. [Medline].
Little JW, Rickles NH. The histogenesis of the branchial cyst. Am J Pathol. Mar 1967;50(3):533-47. [Medline].
Rickles NH, Little JW. The histogenesis of the branchial cyst. II. A study of the lining epithelium. Am J Pathol. May 1967;50(5):765-77. [Medline].
Telander RL, Deane SA. Thyroglossal and branchial cleft cysts and sinuses. Surg Clin North Am. Aug 1977;57(4):779-91. [Medline].
Anand TS, Anand CS, Chaurasia BD. Seven cases of branchial cyst and sinuses in four generations. Hum Hered. 1979;29(4):213-6. [Medline].
Bloch R. Images in emergency medicine. Branchial cleft cyst. Ann Emerg Med. Mar 2006;47(3):291, 308. [Medline].
Rosa PA, Hirsch DL, Dierks EJ. Congenital neck masses. Oral Maxillofac Surg Clin North Am. Aug/2008;20:339-52. [Medline].
Donegan JO. Congenital neck masses. In: Cummings CW, Schuller DE, eds. Otolaryngology - Head and Neck Surgery. 2^nd ed. St. Louis, Mo: Mosby; 1993:1554-9.
Kim MG, Kim SG, Lee JH, Eun YG, Yeo SG. The therapeutic effect of OK-432 (picibanil) sclerotherapy for benign neck cysts. Laryngoscope. Dec 2008;118(12):2177-81. [Medline].

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