Benign nerve sheath tumor in the carotid space

Case contributed by Melbourne Uni Radiology Masters

Presentation

Left neck mass.

Patient Data

Age: 75
Gender: Female
MRI

MRI Head and neck

The previously described left carotid space lesion, with imaging features consistent with a benign nerve sheath tumor, is again demonstrated. There is evidence of gradual growth when compared to imaging dating back three years ago. Otherwise it is unaltered in appearance, again demonstrating prominent high T2 signal peripherally and central low T2 signal, a feature which favors a neurofibroma/schwannoma. It remains well-circumscribed, no evidence of direct invasion, and no lymph node enlargement.

The internal carotid artery is displaced medially, and there is narrowing of the oropharynx. The internal jugular is displaced postero-laterally, compressed between the mass and the deep lobe of the parotid.

Conclusion: Continued gradual enlargement of the left carotid space benign nerve sheath tumor.

Ultrasound

Ultrasound guided neck biopsy

Ultrasound guided biopsy.

Using ultrasound guidance and sterile technique the skin was infiltrated near the angle of the mandible, and an 18 gauge core biopsy needle passed into the carotid sheath mass.

Manual deployment of a 10 mm core biopsy was performed, carefully avoiding arterial structures nearby.

Single sample obtained appeared approximately 4 mm long, and this was sent in formalin for histology.

The patient was recovered in the department, and no immediate complication noted.

Case Discussion

The MR appearances are those of a mass in the carotid space, most likely a nerve sheath tumor.

Ultrasound biopsy showed features of benign peripheral nerve sheath tumor: the morphology is more suggestive of neurofibroma than schwannoma.

 

HISTOPATHOLOGY

CLINICAL NOTES: Left carotid sheath mass ?Schwannoma ?Pleomorphic adenoma ?Carotid body tumor.

MICROSCOPIC DESCRIPTION: The core biopsy shows a proliferation of spindled stromal cells. They have elongated nuclei with no significant nuclear pleomorphism. The cytoplasm is ill-defined. No mitoses or necrosis is seen. The background is loose and myxomatous with thin wavy bundles of collagen. The spindled cells are S-100 positive. They are synaptophysin, smooth muscle actin and CAM5.2 negative. The features are those of benign peripheral nerve sheath tumor. The morphology is more suggestive of neurofibroma than schwannoma.

DIAGNOSIS: Left parapharyngeal mass: Benign peripheral nerve sheath tumor.

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Case information

rID: 38965
Published: 25th Aug 2015
Last edited: 14th Aug 2019
Tag: rmh
Inclusion in quiz mode: Included

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