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Branchial cleft cyst

Cervical masses 4 This case is very interesting. I have seen about 10 cases of this type, that present almost suddenly or growing over one to two weeks to this large size. Ultrasound showed cystic mass, but with very thick wall. The ENT physician referred this case to me because of high suspicion of malignancy. I examined the patient. This was the only mass. Aspiration of the mass revealed typical milky fluid. This milky appearance is usually seen in keratinous debri. I diagnosed it as ruptured Branchial Cleft cyst with inflammation (I also performed cores). I warned the surgeon that the surgery is going to be difficult because of the adhesions. He listened to me, and removed the mass with excellent team to avoid adjacent structures. The mass was removed with surrounding muscle and soft tissue. The diagnosis was confirmed. I am presenting this case because it is very good teaching case for the followings reasons 1- Clinical history of rapidly enlarging mass usually indicate a benign lesion 2- Aspiration of any mass is important part of the diagnosis 3- Type of milk like character of the mass can give the pathologist a great hint about the mass origin (beside the mass location) 4- Doing core is important if residual mass is present (so as not to miss any concurrent malignancy) 5- Communication between the pathologists and the clinician is very important in all cases, especially if the pathologist expect problems during surgery, which makes surgeons avoid a lot of unexpected troubles.