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The utility of ultrasonographic surveillance in management of a presumed branchial cleft cyst later confirmed HPV-associated oropharyngeal cancer
Journal article   Peer reviewed

The utility of ultrasonographic surveillance in management of a presumed branchial cleft cyst later confirmed HPV-associated oropharyngeal cancer

Tatiana Ferraro, Alisha R. Pershad, Shaleen Arora, Esther Lee and Arjun Joshi
Oral oncology, v 151, 106743
01 Apr 2024
DOI: https://doi.org/10.1016/j.oraloncology.2024.106743
PMID: 38460289

Abstract

Branchial cleft cyst Head and neck cancer Human papillomavirus Oropharyngeal cancer Ultrasound
•Cystic neck masses without cytopathologic malignancy present a diagnostic challenge.•Cystic HPV-HNSCC nodal metastases highlight need for improved diagnostic techniques.•U/S surveillance is useful for cystic neck masses of uncertain malignant potential. While branchial cleft cysts are often considered benign pathologies, the literature discusses cases of squamous cell carcinoma (SCC) arising from these cystic lesions as either a primary or metastatic tumor. We illustrate our institutional experience and review the current literature to identify recommendations for best diagnostic, surveillance, and treatment guidelines for SCC identified in a branchial cleft cyst. A 61-year-old male presented with a right sided neck mass, with suspicion of a branchial cleft cyst due to benign findings on fine needle aspiration. Following surgical excision, a focus of SCC was found on surgical pathology. Despite PET/CT and flexible laryngoscopy, no primary tumor was identified prompting routine surveillance every 3 months with cervical ultrasonography and flexible nasolaryngoscopy. Two and a half years following his initial presentation, pathologic right level II lymphadenopathy was detected on ultrasound without evidence of primary tumor. Subsequent transoral robotic surgery with right tonsillectomy and partial pharyngectomy, with right lateral neck dissection revealed a diagnosis of pT1N1 HPV-HNSCC and he was referred for adjuvant chemotherapy and radiation. To our knowledge there are less than 10 cases of confirmed HPV-associated oropharyngeal SCC arising from a branchial cleft cyst. Here we demonstrate the utility of ultrasound as a surveillance tool and emphasize a higher index of suspicion for carcinoma in adult patients with cystic neck masses.

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