Branchial pouch/cleft anomalies

Branchial pouch/cleft anomalies 

Updated: 10/13/2020

© Jun Wang, MD, PhD

General features
  • Congenital lesions
  • Usually 20-40 years old
  • Cysts most common
  • May be bilateral
Clinical presentations
  • May be cyst, sinus, fistula or cartilage in anterolateral neck 
Key pathogenesis
  • Incomplete obliteration of the branchial apparatus
Key morphological features
  • Cysts derived from branchial cleft have squamous epithelium
  • Cysts derived from branchial pouch have respiratory epithelium, with or without squamous metaplasia
Branchial cyst
  • Congenital epithelial cysts
  • Lateral neck
  • Failure of obliteration of the second branchial cleft
  • Solitary, painless mass in the neck of a child or a young adult
  • Intermittent swelling and tenderness during upper respiratory tract infection
  • Fistula after inflammation
  • Cyst with stratified squamous or ciliated columnar epithelium and nonspecific inflammation
  • Treatment: Surgery, antibiotics if infected
Thyroglossal duct cyst
  • Most common congenital neck mass
  • Mean age 30-40
  • Anterior midline neck developmental anomaly due to persistence and cystic dilation of thyroglossal duct
  • Usually asymptomatic
  • May have heterotopic thyroid tissue
  • May appear as blind tubular structure in mid neck or as sinus tract connected to foramen cecum or suprasternal notch skin
  • Cyst with stratified squamous or ciliated columnar epithelium 
  • Treatment: Surgery


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