Ministry of higher education and scientific research

University of Karbala
College of Dentistry

Cervical Lymphoepithelial Cyst

‫ ثائر قاسم علي‬: ‫أشراف الدكتور‬

‫ أماني علي كاظم‬: ‫أعداد الطالبة‬
‫ أمراض فم‬: ‫المادة‬
‫ الرابعة‬:‫المرحلة‬
Introduction
The cervical lymphoepithelial or branchial cleft cyst is a developmental cyst that
has a disputed pathogenesis. The objective of this is to provide a brief review of
the literature and to define diagnostic terms related to this anomaly, as well as to
describe its etiology, clinical presentation and treatment. The cervical
lymphoepithelial or branchial cleft cyst usually presents as a unilateral, soft-tissue
fluctuant swelling that typically appears in the lateral aspect of the neck, anterior to
the sternocleidomastoid muscle, and becomes clinically evident late in childhood
or in early adulthood. Clinicians can diagnose the cyst with appropriate imaging to
assess the extent of the lesion before definitive surgical treatment. The authors
describe a patient who underwent excision of a well-encapsulated cystic structure
that was diagnosed as a branchial cleft cyst.

Pathophysiology / etiology
arises as a developmental anomaly from the second branchial arch in 90 percent of
the cases. Rarely, it arises from the 1st and 3rd arch. Developmental anomalies
arising from branchial arches present
as sinuses, fistulae, cysts or combinations of above. The cyst arises most likely as a
result of incomplete obliteration of branchial cleft with entrapment of epithelial
remnants.Most patients present in 3rd and 4th decade of life as a swelling along the
anterior border
of sternocleidomastoid in the upper neck.the cyst is lined by a thin stratified
squamous epithelium which is usually parakeratinized. Occasional cases may be
orthokeratinzed. Pseudostratified columnar ciliated epithelium with goblet cells
can be found in a minority. The most characteristic feature is the presence of
lymphoid tissue with proper germinal centers . Except in rare cases lymphoid
infiltrate is found below the epithelium in the entire cyst.
Clinical features:
The cervical lymphoepithelial or branchial cleft cyst can be easily misdiagnosed as
a parotid swelling or odontogenic infection. It is imperative that clinicians make an
accurate diagnosis so that appropriate treatment (that is, surgical excision) can be
performed. If the cysts are treated properly, recurrences are rare ..
usually presents as a unilateral, soft-tissue fluctuant swelling that typically appears
in the lateral aspect of the neck, anterior to the sternocleidomastoid muscle, and
becomes clinically evident late in childhood or in early adulthood. Clinicians can
diagnose the cyst with appropriate imaging to assess the extent of the lesion before
definitive surgical treatment. The authors describe a patient who underwent
excision of a well-encapsulated cystic structure that was diagnosed as a branchial
cleft cyst.
 Histologic description
90% are lined by stratified squamous epithelium may/may not keratinized .
Occasional cases may be orthokeratinzed. Pseudostratified columnar ciliated
epithelium with goblet cells can be found in a minority. The most characteristic
feature is the presence of lymphoid tissue with proper germinal centers . Except in
rare cases lymphoid infiltrate is found below the epithelium in the entire cyst. Cyst
wall typically contain lymphoid tissue with germinal centers
• The cyst structure is identical to branchial cleft cyst (Branchial pouch / cleft
anomalies) composed of lymphoid tissue with germinal centers and squamous
lining
• Epithelial lining is attenuated stratified squamous (one or two cells to
approximately seven cells in thickness) or focal respiratory-type epithelium with
ciliated or goblet cells
o Focally can be denuded
o Cyst lumen contains keratin / mucin and debris with cholesterol clefts
• Abundant adjacent lymphoid tissue, lymphoid follicles with prominent germinal
centers common in cyst wall (Hum Pathol 1994;25:1238)
Treatment And Prognosis
It is imperative that clinicians make an accurate diagnosis so that appropriate
treatment that is, surgical excision can be performed.cause the cervical
lymphoepithelial or branchial cleft cyst can be easily misdiagnosed as a parotid
swelling or odontogenic infection If the cysts are treated properly, recurrences are
rare.

CONCLUSION
Cervical lymphoepithelial cyst (CLC) arises as a developmental anomaly from the
second branchial arch in 90 percent of the cases. Rarely, it arises from the 1st and
3rd arch. Developmental anomalies arising from branchial arches present
as sinuses, fistulae, cysts or combinations of above. The cyst arises most likely as a
result of incomplete obliteration of branchial cleft with entrapment of epithelial
remnants.Most patients present in 3rd and 4th decade of life as a swelling along the
anterior border of sternocleidomastoid in the upper neck. It is a fluctuant swelling
ranging from 2 to 10 cm in diameter. Bilateral presentation has rarely been
reported.
REFERENCES
●Chaudhry AP, Yamane GM, Scharlock SE,
SunderRaj M, Jain R. A clinico-pathological
study of lymphoepithelial cysts. J
●Oral Med. 1984;39:79-84.
● JEFFREY W.GLOSSERD.D.S.1CARLOS ALBERTO
● S.PIRESB.D.S.2STEPHEN E.FEINBERGD.D.S., M.S., Ph.D.3
●Wei Yk wang KJ Jou YL and chang YH Branchial ANOMALLY