Adult-Onset Xanthogranulomatous Inflammation Presenting as a Cervical Branchial-Cleft Cyst

Area of Science:

• Head and Neck Pathology
• Histiocytic Disorders

Background:

• Xanthogranulomatous inflammation (XGI) is a rare benign histiocytic reaction.
• Adult-onset XGI within a branchial cleft cyst (BCC) is exceptionally uncommon.

Observation:

• A 71-year-old man presented with a painless lateral neck mass, initially suspected as a benign cyst.
• Intraoperative findings of dense fibrosis and adhesion raised concern for malignancy.
• Frozen-section analysis was crucial for diagnosing XGI and ruling out carcinoma.

Findings:

• This report details the oldest documented patient with adult-onset XGI in a BCC.
• Only three adult cases of BCC-XGI have been reported, all presenting with deceptively benign imaging and significant fibrosis.
• Chronic cyst leakage, potentially exacerbated by fine-needle aspiration, may trigger the xanthogranulomatous response.

Implications:

• XGI should be considered in older adults with fibrotic lateral cervical cysts.
• Prompt intraoperative frozen-section analysis is vital for accurate diagnosis and to guide conservative surgical management.
• Accurate diagnosis prevents overtreatment and unnecessary radical neck dissection.