[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Head and neck](https://durgical.com/en/general-pathology/areas/head-neck/) › Neck cysts and paraganglioma

# Neck cysts and paraganglioma

- Lesion

Lumps unique to the neck: embryonic remnant cysts at the side or midline, and paragangliomas at the carotid bifurcation.

Updated Nov 12, 2026

## Key points

- Branchial cleft cyst (cervical lymphoepithelial cyst): second arch remnant; upper lateral neck along the anterior border of the sternocleidomastoid; young adults.
- Lining: squamous or respiratory epithelium with lymphoid tissue and germinal centres in the wall.
- Thyroglossal duct cyst: midline, moves up with swallowing and tongue protrusion; remnant of thyroid descent from the foramen caecum; can contain thyroid tissue and, rarely, papillary carcinoma.
- Paraganglioma: carotid body tumour at the carotid bifurcation; nests (zellballen) of chief cells with sustentacular cells; chromogranin and synaptophysin, S-100 sustentacular cells.
- About a third of head and neck paragangliomas are hereditary (SDH genes); SDHB mutations carry the highest metastatic risk.
- Histology does not predict behaviour; only metastasis defines malignancy.

On this page

- The basics Key points
- What it is
- Structure
- Step by step
- Congenital and neuroendocrine neck masses
- Markers
- Memory aid
- Elsewhere in DurgiPedia

- Clinical Clinical notes

- Study Test yourself

- Connections Connections

## What it is

Most neck masses are lymph nodes, thyroid or skin lesions covered elsewhere. A few lesions are particular to the neck: branchial cleft cysts on the lateral neck, thyroglossal duct cysts in the midline, and paragangliomas of the parasympathetic paraganglia, the carotid body tumour being the typical one. In adults, a lateral cystic neck mass must be distinguished from a cystic metastasis of HPV-positive carcinoma.

## Structure

- Branchial cyst: well-circumscribed cyst of a few centimetres, watery or mucoid content, lymphoid wall.
- Thyroglossal cyst: cyst lined by squamous or respiratory epithelium, thyroid follicles in the wall in some.
- Carotid body tumour: red-pink to brown, well-vascularised mass enveloping the carotid bifurcation.
- Zellballen: rounded nests of chief cells with clear or granular cytoplasm, separated by delicate vascular septa, rimmed by sustentacular cells.

## Step by step

- Incomplete obliteration of the second branchial cleft leaves an epithelial remnant that fills with fluid later in life.
- The thyroglossal duct normally disappears after the thyroid descends; a persisting segment forms a cyst.
- Paraganglia are neuroendocrine cells of neural crest origin that sense oxygen (carotid body).
- Loss of succinate dehydrogenase causes succinate to accumulate and mimics hypoxia (pseudohypoxia), driving chief cell growth.
- Chronic hypoxia (high altitude) is also associated with carotid body hyperplasia and tumours.

## Congenital and neuroendocrine neck masses

| Lesion | Position | Origin | Key feature |
| --- | --- | --- | --- |
| [Branchial cleft cyst](https://durgical.com/en/conditions/thyroglossal-duct-cyst-and-branchial-cleft-cyst/) | Lateral, anterior to sternocleidomastoid | Second branchial cleft | Lymphoid tissue in the wall |
| [Thyroglossal duct cyst](https://durgical.com/en/conditions/thyroglossal-duct-cyst-and-branchial-cleft-cyst/) | Midline, near the hyoid | Thyroid descent tract | Moves with swallowing |
| Carotid body paraganglioma | Carotid bifurcation | Paraganglion (neural crest) | Zellballen; SDH mutations |

## Markers

- Chromogranin
- Synaptophysin
- S-100 (sustentacular cells)
- SDHB

## Clinical notes

- A lateral neck cyst in an adult over 40 is a cystic nodal metastasis (often HPV-positive oropharyngeal SCC) until proven otherwise.
- Thyroglossal cysts may become infected; surgery removes the cyst with the middle of the hyoid (Sistrunk).
- Carotid body tumours are painless, pulsatile, mobile side to side but not up and down; rarely secrete catecholamines.

## Memory aid

Side cyst from the cleft, middle cyst from the thyroid's path, bifurcation lump from the carotid body.

## Test yourself

Think of the answer, then tap the question to see it.

## Where does a thyroglossal duct cyst occur and why does it move with swallowing?

In the midline near the hyoid bone; it is attached to the tract of thyroid descent and to the hyoid, so it rises with swallowing and tongue protrusion.

## What are zellballen?

Nests of neuroendocrine chief cells separated by delicate vascular septa, the typical pattern of paraganglioma.

## Which gene family is mutated in hereditary head and neck paragangliomas?

The succinate dehydrogenase (SDH) genes; SDHB mutations carry the highest risk of metastasis.

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## Elsewhere in DurgiPedia

- [Branchial cleft cysts, sinuses and fistulas](https://durgical.com/en/embryology/branchial-cleft-cysts-sinuses-and-fistulas/)
- [Thyroglossal duct cyst and ectopic thyroid](https://durgical.com/en/embryology/thyroglossal-duct-cyst-and-ectopic-thyroid/)
- [Pharyngeal clefts and membranes: external ear and cervical sinus](https://durgical.com/en/embryology/pharyngeal-clefts-and-membranes-external-ear-and-cervical-sinus/)

## Connections

## Related 3

- [The ear: otitis media, cholesteatoma, otosclerosis and ear tumours](https://durgical.com/en/general-pathology/the-ear-otitis-media-cholesteatoma-otosclerosis-and-ear-tumours/)
- [Head and neck squamous cell carcinoma](https://durgical.com/en/general-pathology/head-and-neck-squamous-cell-carcinoma/)
- [Pleomorphic adenoma and Warthin tumour](https://durgical.com/en/general-pathology/pleomorphic-adenoma-and-warthin-tumour/)

## Related conditions 2

- [Thyroglossal duct cyst and branchial cleft cyst](https://durgical.com/en/conditions/thyroglossal-duct-cyst-and-branchial-cleft-cyst/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hereditary paraganglioma-pheochromocytoma: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/hereditary-paraganglioma-pheochromocytoma/) (MedlinePlus, US National Library of Medicine, 2025); [Lymphadenopathy](https://www.ncbi.nlm.nih.gov/books/NBK513250/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/neck-cysts-and-paraganglioma/