Branchial cleft cyst presenting as metastatic squamous carcinoma in fine needle aspirates: report of three case

Abstract

A subset of metastatic squamous cell carcinoma of the head and neck presents as cystic masses in the neck. Often, distinguishing between these cystic metastases of squamous cell carcinoma from benign cystic neck lesions, such as branchial cleft cyst, can be very challenging. Squamous lining cells in benign cystic lesions may exhibit significant cytologic atypia, raising concern for squamous cell carcinoma. The challenge in distinguishing benign from malignant cystic squamous lesions of the neck is made more difficult when evaluating fine needle aspiration biopsies given the limited sample size. Herein, three patients with branchial cleft cysts are presented. All were initially diagnosed as metastatic squamous cell carcinomas. The importance of interpretation of fine needle aspiration cytology by an experienced cytologist is emphasized to avoid the possibility of excising metastatic squamous cell carcinomas, which could lead to unnecessary surgical procedures such as radical neck dissection.

Keywords

• Branchial cleft cyst, fine needle aspiration, metastatic squamous cell carcinoma

İnce iğne aspiratlarında metastatik yassı epitel hücreli karsinom olarak saptanan brankiyal yarık kisti: Üç olgu sunumu

Öz

Baş ve boynun metastatik skuamöz karsinomunun bir alt kümesi boyunda kistik kitlelerle ortaya çıkmaktadır. Sıklıkla yassı epitel hücreli karsinomun bu kistik metastazlarını brankiyal yarık kist gibi iyi huylu kistik boyun lezyonlarından ayırt etmek çok zor olabilmektedir. İyi huylu kistik lezyonların iç yüzeyini kaplayan yassı epitel hücreler önemli hücre atipisi gösterebilerek yassı epitel hücreli karsinomdan kaygılanılmasına neden olurlar. Kısıtlı sayıda numune alınan ince iğne biyopsilerini değerlendirirken boynun iyi ve kötü huylu kistik skuamöz lezyonları arasında ayrım yapmak daha çok zorlaşmaktadır. Burada brankiyal yarık kistleri olan üç hasta sunulmaktadır. Hepsine başlangıçta metastatik yassı epitel hücreli karsinom tanısı konmuştu. Gereksiz radikal boyun diseksiyonu gibi cerrahi prosedürlerin uygulanmasına yol açabilen metastatik yassı epitel hücreli karsinom eksizyonu ihtimalinden kaçınmak için deneyimli bir sitolog tarafından ince iğne aspirasyon sitolojisinin yorumlanmasının önemi vurgulanmaktadır.

Anahtar Kelimeler

• Brankiyal yarık kist, ince iğne biyopsisi, metastatik yassı epitel hücreli karsinom

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16. Please cite this article as: Songu M, Aslan H, Baflo¤lu S, Öztürkcan S, Etit D. Branchial cleft cyst presenting as metastatic squamous carcinoma in fine
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