A Case of Cystic Schwannoma in the Neck Masquerading as Branchial Cleft Cyst

Abstract

One-third of schwannomas occur in head and neck region, mostly in the parapharyngeal region. Cystic change is seen in only 4% of schwannomas. The diagnosis of such tumors remains a challenge due to the rarity of these lesions and limited utility of fine needle aspiration cytology. When cystic, branchial cleft cyst is an important differential diagnosis more so due to radiological resemblance. We present a case of 42-year-old male with left sided neck mass masquerading as branchial cleft cyst clinically and radiologically. Multiple sections examined from the cystic areas of the mass revealed lymphoid aggregates beneath the cyst wall in addition to the schwannomatous areas.

Cystic schwannoma of tongue masquerading as mucocele: A cytological pitfall

“…Of all extracranial schwannomas, head and neck region accounts for 25– 45% of the cases whereas intraoral schwannomas are extremely rare and account for only 1% of cases. [ 2 ] Intraoral schwannomas most commonly affect the tongue, followed by palate, buccal mucosa, lip, and gingiva. [ 3 ] Schwannomas affecting the tongue arise from the hypoglossal nerve and vagus nerve.…”

“…Mucinous degeneration, necrosis, hemorrhage, and microcysts formation are thought to be the reasons for these cystic changes. [ 2 ] FNAC in such cases may yield hypocellular fluid altogether missing the solid cellular areas. The aspirated fluid may contain individual spindle cells, fibroblasts, histiocytes, or lymphocytes but in the absence of characteristic cellular architecture, such schwannomas may escape diagnosis.…”

“…FNAC has been found to be of limited value in achieving a preoperative diagnosis in such cystic lesions. [ 2 3 ]…”

Fine needle aspiration cytology of cystic lesions of head and neck

“…This shows that when lateral cervical cystic lesion is encountered a differential diagnosis of neurogenic neoplasm with cystic changes should be included. Bohara S et al 16 reported a case with left neck mass masquerading as branchial cleft cyst clinically and radiologically; however histopathological examination showed it to be schwannoma.…”

Cystic Variation of Schwannoma in the Neck: A Rare Presentation

“…The cystic variants comprise of 4% tumours. [1,4,5] The cystic Schwannoma grows more rapidly than non-cystic type.…”