Medical and surgical approach to a second branchial cleft cyst: Report of a case in the City of Puebla, México

https://doi.org/10.58842/JIDL9976

Incluido en la revista Ocronos. Vol. V. Nº 7–Julio 2022. Pág. Inicial: Vol. V; nº 7: 101-2

Autor principal (primer firmante): Dr. Valeriano Torres Luis Prudencio

Fecha recepción: 11 de julio, 2022

Fecha aceptación: 16 de julio, 2022

Ref.: Ocronos. 2022;5(7): 101-2

Authors:

Valeriano -Torres Luis Prudencio ¹, Heredia – Montaño Heredia ¹, Navarro- Tovar Fernando ¹, Godinez

• Carrillo Alejandro ¹, Velez – Perez Francisco Manuel ¹, Diaz- Barrientos Cheryl Zilahy ^1,2.
  1. Hospital Universitario de Puebla, Benemérita Universidad Autónoma de Puebla.
  2. Sección de Estudios de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México

First author: Dr. Valeriano Torres Luis Prudencio.

Introduction

Based on their etiology, neck masses are usually classified as congenital, inflammatory and neoplastic. In the diagnosis of these masses, it is essential to consider the location; classically divided into medial and lateral, the time of evolution, as well as the presence of local or systemic inflammation.

In general, congenital masses are present at birth, although they can occur at any age. Among these, branchial cleft cysts represent about 20% of congenital lesions in pediatric age, being rare their presentation in adulthood. They present as latero-cervical masses originating from the persistence of transient epithelial structures of the embryogenesis of the head and neck. In this work we report the clinical case of an adult female with the presence of a cyst of the second branchial cleft, focusing on clinical manifestations and surgical approach.

Clinical case

We report the case of a 24-year-old woman, resident of Puebla, Puebla, with no pathological and non- pathological personal history of importance. She started her current condition a year before her admission with the presence of a tumor in the right retroauricular region of approximately 1×1 centimeters in size, associated with burning pain of intensity 7/10 with irradiation to the oropharynx and auricular region, so she went to the doctor who made a diagnosis of parotiditis and treatment with analgesic and unspecified antibiotic was given, She refers partial improvement of the pain without remission of the tumor, with gradual increase in size of the tumor reaching dimensions of 5 x 5 centimeters a week later- She went back to the doctor and was treated with a non-steroidal analgesic, and was scheduled for a re-evaluation in 6 months, however the tumor continued to increase in size, so she went for a re-evaluation 6 months later where the doctor treated her with analgesic and antibiotic based on ceftriaxone, However, the tumor continued to grow, so she went to the family medicine outpatient clinic of the Hospital Universitario de Puebla 1 month before her admission for evaluation, who referred her to the oncologic surgery service and she was protocolized for surgical resolution.

Physical examination revealed: Asymmetrical neck at the expense of right cervical tumor measuring 15 x 10 cm that spans from the mastoid region to the junction of the upper two thirds with the lower third of the sternocleidomastoid in its longitudinal axis, without changes in color, on palpation with well- defined ovoid shape of firm consistency without movement with adherence to deep planes, without palpable lymphadenopathy, Figure 1.

It was decided to perform a fine needle aspiration biopsy, which contained 3 milliliters of cloudy white liquid, the cellular concentrate was spread in 2 slides, which were stained with HE. It is studied by light microscopy. Diagnosis of abundant squamous cells without alterations and eosinophilic proteinaceous material, negative for follicular cells and / or neoplastic cells in relation to gill cyst. On admission with vital signs and laboratory studies in normal parameters. Surgical procedure was performed by Latyshevsky incision with resection of second branchial cleft cyst type I right neck with the following findings: Presence of right second branchial cleft cyst of approximately 8 x 8 centimeters in diameter located below platysma above and medial to sternocleidomastoid and over internal jugular and right carotid, surgical specimen was sent to pathology for study Figure 2. The histopathological study reported cystic tissue covered by keratinized stratified epithelial tissue surrounded by lymphoid tissue with regenerative nodules and smooth muscle cells; in relation to branchial cyst Figure 3.

After the surgical event, she presented adequate improvement, with no data of complication in the immediate post-surgical period, so it was decided to discharge her 24 hours after the surgical procedure. At her follow-up visit one week later, the patient did not report any post-surgical complications.

Discussion

Branchial cyst is a relatively rare pathology of highly disputed origin of highly disputed origin. Congenital theory says that the cysts develop from remnants of the embryonic gill apparatus which is the most accepted theory. Cysts of the second branchial cleft are the most common type, usually located inferior to the angle of the mandible and anterior to the sternocleidomastoid.

In this case, we would like to highlight the importance of a timely and correct approach. Although the initial presentation, as in our case, appeared to be inflammatory, the non-resorption of the tumor and a correct semiology of the lesion should have led to a quicker referral to the surgical service.

It should also be noted that although there is no standard surgical approach for these patients, radial extirpation treatment is the most widely accepted and we want to promote the Latyshevsky technique as a safe option with good surgical and functional results.