CASE REPORT
A 10-year old girl presented with a palpable right neck lump. This was
described as a slow-growing lesion which would intermittently resolve.
On examination a 3 x 2 cm solid, mobile, non-painful lesion was palpated
deep to the anterior border of the sternocleidomastoid muscle. The rest
of the clinical examination was unremarkable. An ultrasound scan (USS)
reported a cystic mass 4.2 x 4.0 x 3.8 cm in diameter with mobile
internal echoes and a diagnosis of a branchial cleft cyst was made
(Figure 1A). An excision via a transverse incision was attempted under
general anaesthesia by a general paediatric surgeon: due to unclear
diagnosis and dense adhesion to neck neurovascular structures, the
procedure was abandoned; an incisional biopsy was therefore obtained,
and histology documented xanthogranulomatous inflammatory change and
fibrosis. A post-operative magnetic resonance imaging (MRI) scan
documented a soft tissue lesion with cystic/fluid components at the
right parapharyngeal space extending to the retropharyngeal space
(Figure 1B); it also confirmed the presence of normal mediastinal
thymus. The patient returned to theatre for formal excision one month
later as a joint procedure by the general paediatric surgeon and an ear
nose and throat (ENT) surgeon. A mixed cystic/solid mass was found
posterior to the sternocleidomastoid muscle, adherent to the carotid
artery and internal jugular vein (IJV) and adjacent to the trachea. The
ansa cervicalis which was densely adherent to the lesion, was identified
with a nerve stimulator and preserved. The lesion was then completely
excised with no significant complications. Histological analysis
revealed an ECT (Figure 1C). The patient remains well at 18 months
follow-up with no evidence of recurrence.