A common disease but rare presentation: branchial cyst located on tonsil

A 35-year-old male patient was admitted with the complaint of swallowing difficulties for 20 days. Physical examination revealed a painless cystic mass lesion 1 × 1 cm in size located on the right palatine tonsil (Fig. 1). There was no additional significant finding in his physical examinations or blood investigations. Computed tomography (CT) revealed a 1 × 1-cm mass lesion located on the right side of the palatine tonsil, which was hypodense to adjunct parenchyma. There was mild contrast enhancement in the border of the lesion proving it to be a cystic lesion (Fig. 2). After total excision of the mass lesion under local anesthesia, patient was discharged with an uneventful recovery, and pathology confirmed the lesion to be a branchial cleft cyst (BCC). BCCs are the congenital neck lesions as a result of incomplete closure of branchial clefts during embryonic development [1] and are classified into four groups according to its location. Moreover, BCCs are the most common type and can occur in any location in the anterior of the sternocleidomastoid muscle extending between clavicle and fossa tonsillaris [2]. Most patients have recourse to clinics with a growing unintentional, painless mass after upper respiratory infection or tooth infections [1]. Even though anamnesis, physical examination, and radiological studies are used for the diagnosis of BCC, histopathological examination provides the definitive diagnosis. CT and magnetic resonance imaging show the structure and anatomical extension of the cyst lesion [3]. The most common treatment of BCCs is total excision [2]. However, true diagnosis and correct surgical technique play an important role in the treatment because an incomplete excision of the cyst may result in recurrence.

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