Vagal schwannoma

Case contributed by Dr Mohamed Abdel-Tawab Mohamed

Presentation

Middle aged female patient presented with right sided cervical swelling.

Patient Data

Age: 25
Gender: Female
CT

A well-defined right carotid space­­­­ mass lesion is seen measuring 3.5 x 4.7 cm. It shows mild enhancement. It takes arterial supply via branches from the external carotid artery. It lies posterior to and displacing the carotid bifurcation anteroromedially and the internal jugular vein anterolaterally.

MRI

A well-defined encapsulated right carotid space mass lesion is seen measuring 3.5 x 5 cm.
It shows T1 low signal and T2 heterogeneously high signal. It shows moderate enhancement. It exhibits diffusion restriction and ADC value of 1.3 x 10 -3 cm3/sec.

Histopathology:

MACROSCOPIC PICTURE: Two cores of tissue, taken by needle biopsy, totally processed.

MICROSCOPIC PICTURE: Microscopic examination of sections from the specimen received revealed the presence of a benign tumour consists of interlacing bundles of elongated cells having wavy nuclei, often arranged in a palisading fashion. The cells are intimately associated with wirelike strands of collagen. There are also loose odematous areas with formation of cystic spaces. These features are in keeping with neurilemoma. No lymph node tissue could be detected in section examined.

CONCLUSION: Cervical mass --- Neurilemoma (schwannoma).

Case Discussion

Vagal schwannoma is an extremely rare tumor that occurs along the path of the vagus nerve (CN X) having its location posterior to the carotid bifurcation (the vagus nerve runs along the posterior aspect of the carotid sheath).

The main differential diagnosis at such location is the vagal paraganglioma, however, schwannoma shows moderate enhancement while paraganglioma shows avid enhancement 1.

The lesion exhibits diffusion restriction and an ADC value of 1.3 x 10-3 cm3/sec attributing some of the diffusion restriction to the high T2 signal 1.

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Case information

rID: 57140
Published: 5th Jan 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Assiut University

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