The diagnosis behind Serena Williams' grapefruit-sized cyst
Key Takeaways
Serena Williams revealed that she recently had a grapefruit-sized cyst removed from her neck.
She underwent surgical excision of the mass, which was diagnosed as a benign branchial cleft cyst.
Prior to the surgical removal, doctors undertook numerous tests that potentially ruled out different diagnoses and guided treatment.
Serena Williams revealed that she recently had a grapefruit-sized branchial cyst removed from her neck.[]
The tennis star disclosed in a TikTok video—in which she had recorded herself in a hospital bed after the operation, with a bandage on her neck—that she found the lump in May 2024. “I immediately went to the doc got a mri and was told I have a brachial cyst,” the 43-year-old wrote in the caption of the video.[]
@serena Back in May I found a lump showing on my neck. I immediately went to the doc got a mri and was told I have a brachial cyst. Have you ever heard of that? They said I don’t need to get it removed if I don’t want. So I did not get it but it kept growing. I decided to get more test and 3 test and one biopsy later everything is still negative but doctors advised I get it removed asap because it was the size of a small grapefruit and it could get infected or worse leak. So this is me removing it. I am feelimg so grateful, and fortunate everything worked out, and most of all I’m healthy. I still made it to American doll with Olympia as promised. And yes all is ok. 🙏🏿🙏🏿 #fyp #foryourpage #serenawilliams #mom ♬ original sound - Serenawilliams
According to Williams, doctors initially suggested the cyst did not require removal, but it kept growing. After undergoing further testing and a biopsy that showed the cyst was “still negative,” doctors advised Williams to have it removed, as “it was the size of a small grapefruit and it could get infected or worse, leak."[]
Defining branchial cysts
These small fluid-filled sacs, which you may know as branchial cleft cysts, branchial cleft anomalies, or pharyngeal cleft cysts, are congenital cysts arising from the 1st to 4th pharyngeal clefts. They are usually diagnosed in children, but noticeable cysts can develop in individuals later in life, as in Williams’ case, as the cysts become infected.[][]
Jerad Gardner, MD, an associate of Geisinger Medical Laboratories at Geisinger Medical Center in Danville, Pennsylvania, has noted that branchial cleft cysts have a distinct pathological appearance, but the key is recognizing where the cyst is on the body. “They are usually below the angle of the jaw in the upper part of the sternum in the sternocleidomastoid muscle,” he said in a YouTube video.[]
Health consequences
While branchial cysts are usually asymptomatic, patients may present with a palpable lump that remains tender, enlarged, or inflamed due to an acute infection. Around 25% present with an enlarged cyst due to secondary infection during an upper respiratory tract infection.
In those situations, your patient may develop an oozing sinus draining to the skin or pharynx. Dysphagia, dyspnea, and stridor are concerning symptoms that can result when a cyst compresses the upper airway.[]
As with Williams, you may send your patient for further testing. This may include imaging, such as a sinogram to determine the cyst’s size and the course of any sinus, or ultrasonography, contrast-enhanced CT, or MRI to determine the characteristics of the cyst.[]
In some cases, fine-needle aspiration is needed to distinguish a branchial cleft cyst from a malignant lesion, such as a cystic squamous cell carcinoma.
Other differential diagnoses to consider include a thyroglossal duct cyst, lymphadenopathy, hemangioma, carotid body tumor, cystic hygroma, ectopic thyroid or salivary tissue, vascular malformations and neoplasms, cat scratch disease, and atypical mycobacterial infections.[]
Soon Sue Rene, MBBS, a senior otorhinolaryngologist at Adult & Child ENT Specialists in Singapore, noted that you perform fine-needle aspiration cytology “to exclude other head and neck diagnoses and cancer before advocating for any form of management.”[]
Surgical indications
You may recommend antibiotics to treat infected cysts. Surgical excision is elective, based on the chance of infection or further enlargement, or the very low malignancy risk. Surgery becomes urgent if the patient’s airway appears compromised or a large abscess is present.[] A partial thyroidectomy may be necessary when 3rd or 4th branchial cleft cysts affect the thyroid gland.[]
According to Dr. Soon, consider surgical removal of the cyst if it is big, cosmetically unsightly, painful, or previously infected.
“This means that essentially, the swelling is not going to disappear. Surgery is needed to completely remove the cyst as well as any communication tracts that we can see,” Dr. Soon said. However, some patients may choose to leave the cyst alone if it is asymptomatic or if it has “been stable for many years.”[]
Discussing her surgery, Williams explained, “Obviously, I went under for it, but they had to put a drain in it because it was so much. But everything worked out, and I feel really happy to have worked with some great doctors.”[]
What this means for you
While branchial cysts are more common in children than adults, consider this diagnosis when your patient presents with a symptomatic swelling on their neck. Educate the child’s parents, or the patient themself if older, on the suitable tests and differential diagnoses. Discuss surgery as a treatment option to remove the cyst if it is growing, painful, or infected, or is compromising the patient’s breathing or ability to swallow.