Case History: The patient was a 39 y/o male who presented with a non-tender swelling on the left lateral side of his neck. It had been growing slowly over the last 2 years to reach the current size of almost 12 cm. It was located in the submandibular region anterior to sternocleidomastoid muscle. Ultrasound showed a low echogenic cystic lesion with absence of internal septation. The cystic lesion was excised. The specimen shows a thin walled cyst measuring 12 cm in its largest diameter. The outer surface is smooth and shows congested blood vessels. The cyst was filled with creamy mucoid material. Microscopic examination confirmed the diagnosis of a branchial cleft cyst. Case courtesy of: Dr. Sanjay D. Deshmukh, Professor of Pathology, Dr. Vithalrao Vikhe Patil Medical College & Hospitals, Ahmednagar, India.