Left vagal schwannoma

Case contributed by Dr Chris O'Donnell

Presentation

Slowly enlarging, non-painful left neck mass. No other palpable mass lesions.

Patient Data

Age: 20
Gender: Male
MRI

Large, well-defined, mass lesion with diffuse enhancement sitting posterior to and displacing the carotid bifurcation anteriorly

Ultrasound

Rounded well-defined, solid mass in the left side of the neck with biopsy needle in situ.  Path result shows a tumor of bland spindle cells devoid of cytological atypia but with nuclear pallisading.  These cells stain with S100.  Appearances typical of Schwannoma.

Case Discussion

Mass lesions intimately related to the carotid bifurcation include lymph nodes, glomus tumors and schwannomas.  Given that this is an isolated lesion, LN seems unlikely but possible.  Glomus tumors are vascular and contain flow voids (salt and pepper appearance). Schwannomas tend be a well defined mass as in this case. It is likely arising from the vagus nerve given its location posterior to the carotid bifurcation (the vagus nerve runs along the posterior aspect of the carotoid sheath).

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Case information

rID: 45482
Published: 1st Jun 2016
Last edited: 14th Aug 2019
System: Head & Neck
Inclusion in quiz mode: Included

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