Unusual case of double fistulation of a brachiogenous cyst

The authors describe a very unusual case of double external metachronous fistulation of a second branchial cleft cyst in a 54-year-old man. Signifi cant difficulties in the clinical differential dia gnosis of this developmental anomaly, comprising primarily malignant tumor and tuberculosis, were resolved only with histopathologic examination of the surgical specimen. The mechanism of the formation of both successively manifesting fistulas, developing in the milieu of chronic non-specific inflammation, is not clear. However, the absence of organoid pattern of the fistulas precludes that they were – unlike the cyst – relicts of the branchial apparatus. Key words branchiogenic cyst – fistula – differential diagnosis