CASE REPORT Russell B. Smith, MD, Section Editor LARYNGEAL CANCER INVOLVING A BRANCHIAL CLEFT CYST Jonathan B. Ida, MD, 1 Matthew W. Stark, MD, 2 Zhenggong Xiang, MD, 2 Mary M. Fazekas-May, MD 3,4 1 Department of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio. E-mail: jonathan.ida@cchmc.org 2 Department of Pathology and Laboratory Sciences, Tulane University School of Medicine, New Orleans, Louisiana 3 Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana 4 Department of Otolaryngology–Head and Neck Surgery, Tulane School of Medicine, New Orleans, Louisiana Accepted 1 April 2010 Published online 13 July 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/hed.21476 Abstract: Background. Benign secondary neck lesions in the setting of laryngeal cancer have been described, but not with branchial cleft cysts. This article describes a branchial cleft cyst in a laryngectomy/neck dissection specimen. Methods and Results. A 44-year-old woman presented to our emergency department with an obstructing laryngeal tumor that was staged as a T4N0M0 squamous cell cancer on the basis of clinical and radiographic findings. After laryngectomy with bilateral neck dissections, the neck specimen contained a right-sided branchial cleft cyst, which was directly invaded by tumor. In addition, the location of the cyst relative to the larynx suggested that this was a third branchial cleft cyst. Conclusion. This is the first report of a laryngeal carcinoma invading a branchial cleft cyst. Staging discrepancies may result from concurrent head and neck lesions, altering treat- ment plans, or changing the prognosis for the patient. Lesions such as this are nearly impossible to diagnose preoperatively, and a high index of suspicion for advanced cancer should be maintained. V V C 2010 Wiley Periodicals, Inc. Head Neck 33: 1796–1799, 2011 Keywords: Branchial cleft cyst; laryngeal cancer; staging; concomitant lesion; extralaryngeal spread Laryngeal cancer is the second most common malig- nancy in the head and neck and is responsible for approximately 3600 deaths annually. 1 Choice of treat- ment modality is dependent on the site and stage of the disease; 5-year survival rates vary accordingly from 36% to 83%. 2 Patients suffer significant morbid- ities related to the disease process and selected ther- apy. These include variable levels of hoarseness or aphonia, dysphagia, xerostomia, aspiration, tracheot- omy dependence, and social stigmata. Accurate staging is imperative in order to choose the most appropriate treatment option and to predict prognosis. The morbidity associated with surgery, radi- ation therapy, and chemotherapy for laryngeal carci- noma varies widely. Any factor that causes inaccuracy in staging compromises the head and neck surgeon’s ability to choose the most appropriate treatment for the patient’s disease and influences the resultant mor- bidity. In addition, it hampers the clinician’s ability to counsel the patient and guide them toward the most appropriate course of therapy. The recent emphasis on patient autonomy and informed consent further sup- ports the importance of accurate cancer staging. We report a case of laryngeal carcinoma whose pa- thology specimen from total laryngectomy and neck dissection contained an unexpected finding that has not previously been reported in the literature. CASE REPORT A 44-year-old woman presented to the emergency department with respiratory compromise and associ- ated dysphonia. Other symptoms included stridor, dysphagia, hoarseness, and throat pain which had increased in severity in the weeks before presenta- tion. She denied a neck mass, hemoptysis, and weight loss. Social history was positive for 30 pack-years of smoking and significant alcohol consumption. She also had poorly controlled diabetes and hypertension and had a surgical history of toe amputations and vascular bypass surgeries of the lower extremities for peripheral vascular disease. On examination at pre- sentation, the patient was stridorous and displayed increased work of breathing but maintained adequate oxygen saturation. She was nearly aphonic but was alert and oriented. A palpable swelling in the right side of the neck was noted, lateral to the thyroid car- tilage. There was no palpable lymphadenopathy. Flex- ible nasopharyngoscopy showed a large, exophytic Correspondence to: J. B. Ida This work was presented as a poster at the American Academy of Otolaryngology/Head and Neck Surgery Annual Meeting in San Diego, California, October 2009. V V C 2010 Wiley Periodicals, Inc. 1796 Laryngeal Cancer Involving a Branchial Cleft Cyst HEAD & NECK—DOI 10.1002/hed December 2011