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CASE REPORT
Year : 2013  |  Volume : 14  |  Issue : 1  |  Page : 33-35

Cervical chondrocutaneous branchial remnants: Two cases report


1 Department of E.N.T, Hôpital Militaire d'Instruction Mohammed V, Rabat, Morocco
2 Department of E.N.T and Plastic Surgery Unit, Hôpital d'Enfants, CHU IBN SINA, Rabat, Morocco

Date of Web Publication23-Aug-2013

Correspondence Address:
Nawfal Fejjal
Secteur, 23, Résidence Nakhil Riad, Immeuble 14, Apt 4, Hay Riad, Rabat 10100
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.116858

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  Abstract 

Cervical chondrocutaneous branchial remnants are rare and badly known lesions, located in the lower third of the lateral neck. They are similar in appearance to preauricular tags. Histologically, the lesion per definition presents as a choristoma. Treatment involves complete surgical removal in order to make an exact histopathological diagnosis. The authors report two cases, review the literature and discuss embryologic and diagnostic aspects.

Keywords: Branchial remnants, cartilaginous choristoma, congenital tumor, neck


How to cite this article:
Hemmaoui B, Fejjal N, Nadour K, Benariba F. Cervical chondrocutaneous branchial remnants: Two cases report. Indian J Paediatr Dermatol 2013;14:33-5

How to cite this URL:
Hemmaoui B, Fejjal N, Nadour K, Benariba F. Cervical chondrocutaneous branchial remnants: Two cases report. Indian J Paediatr Dermatol [serial online] 2013 [cited 2019 Sep 20];14:33-5. Available from: http://www.ijpd.in/text.asp?2013/14/1/33/116858


  Introduction Top


Cervical chondrocutaneous branchial remnants (CCBR) are uncommon and not well-known congenital lesions. There are few descriptions in the literature concerning pure chondrocutaneous rests in the lower neck region and even fewer descriptions concerning bilateral chondrocutaneous rests. In 1997, Atlan et al. described their findings in 20 retrospective evaluated cases of cervical skin tags and suggested the term "chondrocutaneous branchial remnants" in order to adopt a clear widely acceptable name for these malformations.

Treatment of these lesions is complete surgical removal as promptly as possible.

We report two cases of congenital bilateral and unilateral chondrocutaneous branchial remnants of the neck and discuss embryologic and diagnostic aspects.


  Case Reports Top


Case 1

A 3-year-old boy admitted to the clinic with bilateral, painless, pedunculated masses in the lower neck anterior to the sternocleidomastoid. Each mass measured about 12 mm. No signs of inflammation or infection were noted upon palpation. The mother stated that these masses were noticed directly after birth and have not grown since then. The mother denied any family history of neck masses. The physical examination of patient revealed an otherwise healthy and well-developed child. The excision of both lesions was performed under general anesthesia. These lesions appeared to be solid cartilaginous masses covered by normal-appearing skin. During the operation no sign of fistulization or communication to underlying structures was seen. The histological examination confirmed bilateral ectopic cartilage remnants. No recurrence was noted during the child's follow-up.

Case 2

A 9-year-old girl presented with a right pedunculated tumor in the lower third of the neck, anterior to the sternocleidomastoid [Figure 1]. The tumor measured about 1.5 cm. No other swellings were present. The lesion had a firm, but elastic consistency and was mobile in relation to its underlying structures. The excision of the lesion was performed under general anesthesia. The histological examination confirmed the ectopic cartilage remnants [Figure 2]. No recurrence was noted during the child's follow-up.
Figure 1: Unilateral pedunculated tumor in the lower right half of the neck

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Figure 2: Details of cartilage and dermal tissue (H and E, ×40)

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  Discussion Top


During the embryonic phase, the branchial arches are initially positioned in a ventral position and migrate along the sternocleidomastoid muscle to a more cranial position. [1] Cells that are left behind during this process, can give rise to the formation of CCBR. [2],[3] This explains why they are frequently attached to the sternocleidomastoid muscle as was the case for our patients.

Atlan et al. in the literature, [4],[5] consider that the possible origin of CCBR may be divided into two groups. One states that these lesions are derivatives of auricular tissue as the other group considers that these lesions originate from branchial tissue (lower arches).

The inspection of the type of cartilage found in the remnants can give an idea on the origin: Elastic cartilage would suggest an auricular (first or second branchial arch) origin or perhaps a possible derivate of the lower neck (fourth through six branchial arches), hyaline cartilage on the other hand would suggest a cervical source (second or third branchial arches). [5],[6]

These malformations are characterized by predominance among males, scarcity of bilateral lesions and the presence of a cartilage core and a high incidence of associated anomalies. Their clinical features are the following: Present at birth and located in the middle or lower third of the neck with a significant prevalence anterior to the sternocleidomastoid muscle. The overlying skin is similar to the surrounding neck skin and the lesion is painless, lacking any inflammation or discharge. [7]

CCBR require, despite their clear clinical markings, a broad differential diagnosis. [8] This latter include thymic and thyroglossal duct cysts, branchial cleft cysts, hair follicle nevus, congenital midline hamartomas, fibroepithelial polyps, epidermoid cysts and squamous papillomas. Thymic cysts are lined by stratified squamous epithelium and fluid-filled. Thyroglossal duct cysts are located in the anterior neck and can sometimes contain thyroid follicles. Branchial cleft cysts are located in the lateral neck and are lined with upper respiratory epithelium; they have a shallow epidermal pore and contain seromucinous glands. Congenital midline hamartomas have a prominent skeletal muscle component and are found on the anterior mandibula. Epidermoid cysts, squamous papillomas and fibroepithelial polyps do not usually involve differential diagnostic difficulties. [1]

The surgical treatment of these remnants is a simple excision extending to the superficial neck musculature, which was done in our case and proved sufficient.

Although it is stated in the literature that branchial system malformations are commonly associated with other congenital defects, [4],[5],[7] no other malformations were found in our two cases.


  Conclusion Top


Cervical chondrocutaneous branchial remnants (CCBR) are very rarely reported congenital entity. Here we reported two cases of congenital bilateral and unilateral chondrocutaneous branchial remnants of the neck and discussed the embryologic and diagnostic aspects too.


  Acknowledgment Top


RATBI Ghizlane and Professor Saidi (Nations Unies histopathology center), are acknowledged for their help and re-reading the manuscript.

 
  References Top

1.van Kalkeren TA, Frima-van Aarem A, Ahsmann EJ, Mahieu HF. Case report of a unilateral cervical chondrocutaneous branchial remnant. Int J Pediatr Otorhinolaryngol Extra 2007;2:225-7.  Back to cited text no. 1
    
2.Beard JS, Sperling L. Picture of the month. Congenital cartilaginous rests of the neck (wattles). Arch Pediatr Adolesc Med 1994;148:211-2.  Back to cited text no. 2
[PUBMED]    
3.Larsen WJ. Development of the ears. Human Embryology. 2 nd ed. Cincinnati: Churchill-Livingstone; 1997. p. 385-92.  Back to cited text no. 3
    
4.Atlan G, Egerszegi EP, Brochu P, Caouette-Laberge L, Bortoluzzi P. Cervical chrondrocutaneous branchial remnants. Plast Reconstr Surg 1997;100:32-9.  Back to cited text no. 4
[PUBMED]    
5.Tamir S, Nidal M, Constantin R, Perez R, Sichel JY. Bilateral cervical chondrocutaneous branchial remnants. Int J Pediatr Otorhinolaryngol Extra 2008;3:117-9.  Back to cited text no. 5
    
6.Oztürk H, Ozdemir T, Demirbað S, Atabek C, Sürer I, Safali M, et al . Bilateral cervical chondrocutaneous remnants: A case report and review of the literature. Turk J Pediatr 2006;48:175-7.  Back to cited text no. 6
    
7.Braun H, Hofmann T, Wolfgruber H, Anderhuber W, Beham A, Stammberger H. Case report of bilateral cervical chondrocutaneous branchial remnants. Int J Pediatr Otorhinolaryngol 2003;67:89-92.  Back to cited text no. 7
    
8.Rund CR, Galyon SW, Fischer EG. Pathologic quiz case: An anterior neck mass in a 5-month-old female infant. Wattle (congenital cervical tragus). Arch Pathol Lab Med 2004;128:1453-4.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Cervical chondrocutaneous branchial remnants – Report of 17 cases
Ninoslav Begovic,Radoje Simic,Aleksandar Vlahovic,Djordje Kravljanac,Slavisa Djuricic,Tanja Mijovic
International Journal of Pediatric Otorhinolaryngology. 2014;
[Pubmed] | [DOI]



 

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  In this article
Abstract
Introduction
Case Reports
Discussion
Conclusion
Acknowledgment
References
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