A Rare Case of Vagus Nerve Schwannoma Presenting as a Neck Mass

Abstract

Patient: Female, 55Final Diagnosis: Left vagal nerve schwannomaSymptoms: DysphagiaMedication: —Clinical Procedure: SurgerySpecialty: Internal MedicineObjective:Rare diseaseBackground:Vagus nerve schwannoma is a benign neoplasm that usually presents as an asymptomatic slow growing mass, and its presentation as a neck mass is rare. The diagnosis can be difficult to make and complete surgical excision is challenging due to the proximity of the vagus nerve fibers from which it originates. The most common symptom associated with vagus nerve schwannoma arising in the neck is hoarseness due to vocal cord palsy.Case Report:We report a case of a 55-year-old woman who presented to the clinic complaining of throat irritation and feeling of something stuck in her throat for the past three months. On examination, a bulging left parapharyngeal mass was noted, displacing the left tonsil and uvula medially. A contrast-enhanced computed tomography (CT) scan of the neck showed a large, hypervascular soft tissue mass with splaying of the left internal carotid artery. Intraoperatively, the tumor was found to be arising from the vagus nerve. Macroscopic surgical pathology examination showed a tan-red, ovoid, and firm mass. Histopathology showed a benign spindle cell tumor with Antoni A areas with palisading cell nuclei and some degenerative change, confirming the diagnosis of vagus nerve schwannoma.Conclusions:Vagus nerve schwannomas should be distinguished from other tumors that arise in the neck before planning surgery, to minimize the risk of nerve injury. Physicians need to be aware of the differential diagnosis of a neck mass, investigations required, the surgical treatment and the potential postoperative complications.

Vagal nerve schwannoma: a rare case from Border Security Force Composite hospital

“…Approximately 25-45% of extracranial schwannomas are present in the head and neck area; the most commonly affected region are the temporal bone, lateral neck and paranasal sinus. 3 The involvement of vagus nerve has been reported in 10% of cases. Most Schwannomas occur between the 3rd and 6th decade of life, affecting both the gender equally, and have minimal risk of malignant transformation.…”

A giant vagal Schwannoma: a case report

“…1−3 Epidemiology demonstrates that these tumors affect mainly adults between the third and sixth decades of life, with similar involvement in both genders. 2,4 Usually benign, Schwannomas are asymptomatic tumors with minimal risk of malignant transformation, slow growth with an increase ratio of 2.5 to 3mm per year, tending to be diagnosed late as large, encapsulated and with poorly mobile solid masses. Despite radiological characteristics well described, the diagnosis can only be confirmed after complete resection of the tumor and its anatomopathological evaluation.…”

Sonographic appearances of adrenal schwannomas

“…Schwannomas are usually benign slow‐growing tumors, and are rarely malignant . Most commonly, schwannomas present as a solitary well‐encapsulated subcutaneous tumor in otherwise healthy individuals . Multiple schwannomas are rare and most often seen in patients with neurofibromatosis type 2 …”

“…4,5 Most commonly, schwannomas present as a solitary well-encapsulated subcutaneous tumor in otherwise healthy individuals. 6 Multiple schwannomas are rare and most often seen in patients with neurofibromatosis type 2. 7 Although schwannomas can involve any anatomic site where Schwann cells are present, they generally develop from the cranial and peripheral nerves of the head, neck, or the flexor surfaces of the extremities and trunk.…”