A second branchial cyst, masquerading as lipoma, a mistaken diagnosis supported by radiology and fine needle aspiration cytology: case report

Abstract

At the fourth week of embryonic life, the development of four branchial clefts result in five branchial arches, which contribute to the formation of various structures in the head and neck. We report a case of second branchial cleft cyst in a 50 years old lady for last 30 years. The cyst did not develop any complication in spite of long duration. The mass had been evaluated in past and she underwent ultrasonography (USG) and fine needle aspiration cytology (FNAC).  Again, we evaluated the patient with USG, contrast enhanced computer tomography (CECT) and FNAC. The final diagnosis on both the occasions was lipoma neck. The mass was found to be second branchial cyst on exploration under local anaesthesia and same was confirmed by histopathology. We wish to highlight the limitation of radiology and cytology the diagnosis of branchial cleft cysts. The magnetic resonance imaging (MRI) may have clinched the exact diagnosis, which was not done in this case. The operating surgeons should always keep in mind these limitation and be prepared for surprises in dealing with the neck masses.