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praclavicular tumours) [15, 58]. There is no doubt that most, if not all of them are actually cervical node metastases with a cystic pattern. The palatine tonsil, or more generally the anatomic region of Waldeyer's ring, is notorious for producing cystic solitary metastases that resemble the usual appearance of branchial cleft cysts [69, 73, 96, 116].

All of the suspected branchiogenic carcinomas have been squamous-cell in type, and all but one have been in the region of the second branchial apparatus [15, 58, 86]. The patients have been predominantly males ranging in age from 38 to 71 years [15, 58]. Nearly all of these masses have been cystic and have resided in a lymphoid matrix, hence the presumed relationship to a branchial cyst. It should be obvious that neither cystic architecture nor association with lymphoid tissue is, in itself, an acceptable criterion for diagnosis of branchiogenic carcinoma [73, 96, 116].

An absence or presence or peripheral lymphatic sinuses and/or follicular centres in the lymphoid tissue has been used to exclude or confirm metastasis to the lymph nodes. This criterion is not valid. Branchial cleft cysts often lie within lymph nodes, and metastases can obscure the architecture of a lymph node [96, 116].

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