Management of second branchial cleft abnormalities in adults

Management of second branchial cleft abnormalities in adults. Objective: Branchial cleft anomalies are developmental disorders of the neck. Our aim is to report the diagnostic and treatment procedure followed in three cases of second branchial cleft abnormalities in adults. Methodology: A patient aged over 40 underwent surgical excision of a well-encapsulated cystic neck structure and two further patients of a branchial sinus and branchial fistula respectively. Prior to surgery the patients were assessed by means of imaging techniques, FNA cytology and cytometric DNA analysis. Results: Neutrophils, debris, mature squamous epithelial cells including degenerate forms and lymphoid cells were the key features in the cytological diagnosis. DNA analysis of the pre-operative cytological material in two cases revealed euploidy, thus indicating no malignancy. Histological examination of the lesions after excision established the diagnosis in all cases. No recurrences were reported. Conclusions: Although congenital lesions, the second branchial cleft abnormalities usually present in adulthood and have to be distinguished from benign and malignant lateral neck swellings. FNA cytology as well as DNA ploidy determination contributes to the establishment of the diagnosis of branchial cleft abnormalities and their differential diagnosis.