Head and Neck Cystic Lesions: A Cytology Review of Common and Uncommon Entities

Abstract

<b><i>Background:</i></b> Cystic lesions of the head and neck are a diagnostic challenge since they are seen in the clinical presentation of a wide variety of conditions. Herein, common and uncommon entities that present as cystic lesions in the head and neck are reviewed. <b><i>Summary:</i></b> In this study, peer-reviewed articles were selected using the database PubMed, Google, Google Scholar, and Scopus. Emphasis was placed on peer-reviewed articles that discuss the cytomorphology and differential diagnosis of entities that present as cystic lesions of the head and neck. In the anterior neck, both benign and malignant neoplasms can present, including papillary thyroid carcinoma (PTC), thyroid adenomatoid nodule, parathyroid cysts, and thyroglossal cysts. In the lateral neck, branchial cleft cyst, PTC, ectopic thyroid cyst, and squamous cell carcinomas (human papilloma virus and non- human papilloma virus-related) are common. Age over 40 years raises the possibility of malignancy. In the deep neck, mostly benign cystic entities occur such as a pleomorphic adenoma, paraganglioma, schwannoma, branchial cyst, epidermal inclusion cyst, and lymphoepithelial cyst. Lesions with squamous cell features can pose diagnostic dilemmas. <b><i>Conclusion:</i></b> Cytologic examination of head and neck cysts can provide valuable information regarding the nature of the cystic lesions. Information about anatomic site and clinical history can assist with the differential diagnoses. Ancillary studies can improve the diagnosis in some cases. Each case should be evaluated very carefully since there are a wide variety of congenital conditions, infectious/inflammatory conditions, benign neoplasms, and primary and secondary malignancies presenting as a cystic mass in the head and neck.

Cystic Salivary Gland Neoplasms: Diagnostic Approach With a Focus on Ancillary Studies

“…Following this trend, there are now commercially available tests that seek to replicate this strategy with respect to salivary gland neoplasms 45. As molecular technologies continue to advance, we will likely see an increase in the use of molecular testing in the evaluation of cystic salivary gland neoplasms, as is routine in cystic lesions of other organs such as in the pancreas 8…”

“…5 Here, we present a summary of the current approaches to the differential diagnosis of cystic salivary gland neoplasms with a focus on those entities which have recently been shown to harbor molecular signatures, thus enabling the use of different ancillary studies for improving diagnostic accuracy. [6][7][8][9]…”

Current approach to branchial remnants in the neck

“…Moreover, the differential diagnosis should include extremely rare circumstances, such as associating xanthogranulomatous inflammation [ 26 ]. Vazquez Salas et al recently published one of the most comprehensive reviews of FNAB cytology diagnosis of uncommon cystic lesions in the head and neck region [ 27 ]. Nonetheless, there should also be a certain focus on genetic conditions, such as branchio-oto syndrome (BOS)/branchio-oto-renal syndrome (BORS), which is an autosomal dominant heterogeneous disorder uniting hearing impairment and abnormal phenotype of ears, accompanied by renal malformation and branchial cleft anomalies including cyst or fistula [ 28 ].…”

“…Vazquez Salas et al recently published one of the most comprehensive reviews of FNAB cytology diagnosis of uncommon cystic lesions in the head and neck region [27].…”

The Rare Third Branchial Cyst in Paediatric Age Group

“…They are found equally in both males and females. Branchial cleft cysts are typically seen in young age group but can be found in any age group or present in utero (2). Third branchial cleft cysts are amongst the rare branchial cysts representing only 2-8% of all branchial anomalies and are presented as a painless mass that develops rapidly in the neck following an infection (3).…”