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

INTRODUCTION

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.

CASE REPORT: 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.

CONCLUSION

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.