Nasopharyngeal Branchial Cleft Cyst in an Elderly Man: An Atypical Presentation

Branchial cleft cysts (BCCs) account for nearly one-third of congenital cervical masses, but their occurrence within the nasopharynx is exceedingly uncommon. Most reported nasopharyngeal cases involve children or young adults; presentation in older patients raises concern for cystic metastasis from an occult head and neck malignancy.

We describe a 64-year-old man with a three-year history of progressive bilateral nasal obstruction and recurrent rhinosinusitis. Endoscopy disclosed a smooth, mobile, midline pinkish nasopharyngeal mass; cross-sectional imaging confirmed a well-defined T2-hyperintense cystic lesion in the upper posterior nasopharynx. Endoscopic transnasal piecemeal excision was performed, and histopathology established a branchial cleft cyst without dysplasia or malignancy. The patient remained asymptomatic on follow-up.

This case underscores the importance of including nasopharyngeal BCC in the differential diagnosis of cystic nasopharyngeal lesions, even in elderly patients in whom cystic carcinoma metastasis must first be excluded.