Vagal schwannoma

Case contributed by Mohamed Abdel-Tawab Mohamed


Middle aged female patient presented with right sided cervical swelling.

Patient Data

Age: 25 years
Gender: Female



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 anteromedially and the internal jugular vein anterolaterally.


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 mm2/sec.


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 tumor 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 edematous 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 mm2/sec attributing some of the diffusion restriction to the high T2 signal 1.

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