Posterior cervical space nerve sheath tumour

Case contributed by Dr Sara Wein

Presentation

Left neck lump

Patient Data

Age: 34
Gender: Male
Modality: MRI

The mass is oval, sharply circumscribed, and heterogeneous centrally, with a thick irregular peripheral pattern of enhancement, and either necrotic or partially cystic core. 26 x 31 x 38 mm, the lesion lies deep to the left sternocleidomastoid, displaces the common and internal carotid arteries medially, compresses the jugular vein although is separate from it, and could best be characterised as a carotid space mass.

Superiorly it reaches to the deep lobe of the left parotid gland, inferiorly for 3.8 centimetres. Surrounding fat planes are normal.

There are numerous enlarged lymph nodes along the jugular chain bilaterally, the largest at the jugulodigastric level on each side-on the right and 12 and 11 mm in diameter respectively, and on the left 15 mm long axis. None of the nodes have high risk morphology in terms of necrosis or infiltration of surrounding tissues.

Conclusion:

The most likely diagnosis is of a nerve sheath tumour-with reactive but not malignant numerous bilateral jugular chain lymph nodes.

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Case Information

rID: 34378
Case created: 17th Feb 2015
Last edited: 11th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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