Fine needle aspiration cytology of a neck node shows epithelial-lined cyst with lymphoid stroma and squamous lining in a 50-year-old smoker. This appearance is most consistent with:

• A Second branchial cleft cyst
• B Cystic metastasis from HPV-related oropharyngeal SCC ✓
• C Thyroglossal duct cyst
• D Reactive lymphadenitis with cystic change

Explanation

Cystic lateral neck masses in adults over 40 should be considered metastatic until proven otherwise — particularly HPV-related oropharyngeal squamous cell carcinoma (tonsillar or base-of-tongue) which classically presents as a cystic neck node metastasis mimicking a branchial cyst. The squamous lining and lymphoid stroma on FNAC, combined with the age and smoking history, should trigger investigation for oropharyngeal primary (including tonsil biopsy and PET-CT). Dismissing it as a branchial cyst in an adult over 40 is a dangerous error.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.