Unusual clinical course, Challenging differential diagnosis
Adesh A. Ramdass, Mike Yao, Suneetha Natarajan, Parampreet K. Bakshi
(Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, NY, USA)
Am J Case Rep 2017; 18:908-911
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.
Keywords: Neurilemmoma, Vagus Nerve Diseases, Vocal Cord Paralysis