Branchial Cleft Cyst

Branchial Cleft Cyst

Lester D. R. Thompson, MD

The lumen of this BrCC is filled with keratinaceous debris. There is a thin, squamous epithelium image without any atypia. There is a germinal center image within the associated lymphoid tissue.

The cyst is lined by metaplastic squamous epithelium although a residuum of columnar epithelium is still present image. There is a very thin basement membrane between the epithelium and lymphoid tissue.



  • Branchial cleft cyst (BrCC)


  • By convention, “branchial cleft cyst” refers to congenital developmental lateral cervical cyst derived from remnants of 2nd branchial apparatus

    • Encompasses branchial cyst, sinus, or fistula


Branchial Apparatus

  • Precursor of many head and neck structures

  • 2nd branchial arch overgrows 2nd, 3rd, and 4th clefts

  • This overgrowth forms “cervical sinus”

  • Embryogenesis is usually complete by 6-7 weeks of gestation

  • Failure of obliteration of cervical sinus results in 2nd branchial cleft remnant (cyst, sinus, or fistula)

  • 2nd branchial cleft fistula extends from skin anterior to sternocleidomastoid muscle (SCM), through carotid artery bifurcation to terminate in tonsillar fossa

  • 3rd and 4th branchial cleft cysts are very uncommon (< 5%)

    • Recurrent neck abscess or acute suppurative thyroiditis

    • Vast majority on left side (90-95%)

  • Some posit cystic transformation of cervical lymph nodes

    • Especially in adults



  • Incidence

    • Uncommon

      • Still, BrCC is one of the most commonly encountered congenital anomalies in pediatric otolaryngic practice

      • Thyroglossal duct cysts are most common

    • BrCC accounts for ˜ 20% of all congenital cervical cysts

      • Cysts > > sinuses (3:1)

    • About 80-90% of all branchial cleft anomalies are 2nd branchial cleft cysts

  • Age

    • Bimodal presentation

      • < 5 years old (25%)

      • 20-40 years old (75%)

      • ˜ 1% in patients > 50 years old

  • Gender

    • Equal sex distribution


  • Lateral neck near mandibular angle

  • Along anterior border of SCM

    • Anywhere from hyoid bone to suprasternal notch

  • Curiously, left-sided predominance for 4th branchial anomalies (> 90%)


Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Branchial Cleft Cyst

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