Cervical schwannoma.

A 60-year-old Hispanic man presented with a 3-year history of a progressively enlarging left neck mass. He denied any dyspnea, hoarseness, or otalgia. The mass was mobile, nonpulsatile, and nontender, and it measured 7 X 12 cm. Otherwise, findings on the complete head and neck examination were unremarkable.

Fine-needle aspiration biopsy yielded fragments of atypical squamous and stromal cell components. Computed tomography (CT) of the neck detected a left-sided 12 X 10 cm cystic mass that had anteriorly displaced the carotid artery and jugular vein (figure 1). The differential diagnosis included a cystic neoplasm, an infected branchial cyst, and an atypical lymphangioma.

[FIGURE 1 OMITTED]

The patient underwent a left neck exploration with excisional biopsy. Intraoperatively, the mass was noted to be intimately associated with a cervical nerve root (figure 2,A). It had a pseudocapsule that encompassed the left internal jugular vein and carotid artery (figure 2, B). Preservation of the originating nerve was not possible, but all other surrounding neurovasculature was spared. Histopathologic findings were consistent with a schwannoma. The patient had no postoperative neurologic complaints.

[FIGURE 2B OMITTED]

Neurilemmomas are benign tumors of Schwann cell origin. They can arise anywhere in the body, but they have a predilection for the head and neck. The most common sites in the head and neck are the lateral neck and the middle ear. Presentation varies according to the site of the lesion. Typically, schwannomas present as solitary, painless neck masses. Rarely do they present with pain, paresthesias, or other focal neurologic deficits. The differential diagnosis includes solitary neurofibroma and neurofibroma associated with von Recklinghausen's disease. On gross examination, these tumors tend to be rubbery and firm, and they are often attached to an identifiable nerve. Their distinctive histologic features include alternating regions of compact and loose hypocellular spindle-cell zones made up of Antoni A and Antoni B cells, respectively. Whorling or palisading of nuclei (Verocay bodies) may also be seen.

The treatment of choice is surgical excision. Because these tumors are benign, every effort should be made to preserve the nerve of tumor origin and all other surrounding neurovascular structures. In cases in which a complete resection would result in significant morbidity, a subtotal resection may be carried out.

Suggested reading

Benito Orejas JI, Poncela Bolanco M, Morais Perez D, et al. [Neck schwannomas]. An Otorrinolaringol Ibero Am 2001 ;28:477-85.

Llorente Arenas EM, Vicente Gonzalez E, Adiego Leza I, et al. [Lateral cervical tumor of neural etiology: Cervical schwannoma]. An Otorrinolaringol Ibero Am 2001 ;28:233-40.

Saiki M, Taguchi T, Kaneko K, et al. Measuring of the compensation of a nerve root in a cervical schwannoma: A case report. J Orthop Sci 2003;8:714-16.

Jason Hamilton, MD; Ryan Osborne, MD; Sofia Avitia, MD; Helen Xu, MD