Branchial cleft cyst in an aged patient: a challenging differential diagnosis

Abstract

We present a case of a 70-year-old male patient with a personal history of stable multinodular goiter. Thyroid function tests were normal. Cervical ultrasound showed a well-defined anechoic lesion in the thyroid right lobe. Fine needle aspiration biopsy and subsequent cytological examination revealed, respectively, a yellow and thick fluid, and superficial squamous cells without other alterations, favouring extrathyroidal origin. Dysphagia and dyspnea led to a cervical Computed Tomography, which showed the exact same lesion producing moderate left tracheal shift. Right hemithyroidectomy resumed the aforementioned symptoms. Histopathological examination of the surgical specimen revealed a cystic lesion covered by stratified pavement epithelium, consistent with an intrathyroidal branchial cleft cyst. A high level of suspicion is critical, regarding the comprehensive differential diagnosis of cervical masses, as other more frequent and well-known congenital anomalies.