Malignant first branchial cleft cysts presented as submandibular abscesses in fine-needle aspiration: report of three cases and review of literature.

Malignant branchial cleft cyst is a rare entity. To the best of our knowledge, there have been one case of malignant first branchial cleft cyst and 13 cases of malignant second branchial cleft cysts in the literature that fulfill Khafif's modified criteria since 1982. We have encountered three such cases, presenting as unilateral submandibular abscesses, refractory to antibiotics, from men of 52, 53, and 61 years of age. Fine-needle aspiration was reported as "abscess" in the first case, "atypical squamous cystic lesion" in the second case, and "atypical first branchial cleft cyst" in the third case. Histopathology showed Type II malignant first branchial cleft cysts with in situ squamous-cell carcinoma in one patient and in situ and invasive squamous-cell carcinoma in the other two patients. Patients are alive and disease-free 3-4.5 years post-surgery and -radiation. Awareness of this extremely rare entity can potentially avoid underdiagnosis by the cytopathologist and overtreatment by the surgeons.