This female patient of 32 years was treated by me 10 years ago for fistula at neck and Dacrocystitis with fistulae on Rt Side of eye and neck respectively with ATT (ESR was 80, MT highly positive 10 years ago). Now she again developed neck swelling Now she again developed neck swelling, painful, soft cystic. FNAC done directly without CBC, the report shows granuloma, caseation material, and histiocytes.

No other constitutional symptoms present. Should prefer to surgery or treat medically?