A Rare Case of Cervical Vagal Nerve Schwannoma in a 30-Year-Old Ethiopian Man

Abstract

Schwannoma is a slowly growing benign tumor that arises from Schwann cells. Schwannomas affect both genders equally. It occurs in any age group, but most cases are seen between the third and fifth decade. About one-fourth to one-third of extracranial schwannomas cases originate in the head and neck region. The vagus nerve, followed by the cervical sympathetic chain, is the leading site of origin in the neck region. The majority of patients with schwannomas are asymptomatic. Patients with vagal nerve schwannomas in the neck primarily present with hoarseness of voice due to paralysis of the vocal cords. Because of their rarity and the lack of a neurologic deficit as a presenting symptom, preoperative consideration of schwannomas is tough, and several differential diagnoses may be entertained.The mainstay of treatment for vagal nerve schwannoma is complete surgical excision. Here we present a rare case of cervical vagal nerve schwannoma in a 30-year-old male farmer from Ethiopia. The patient presented with a gradually increasing neck swelling of 10 years duration. He started to have hoarseness in his voice five months prior to his presentation. On examination, he had a huge anterior neck swelling. He had two FNAC results, which were inconclusive, and a neck CT. With the consideration of multinodular goiter versus spindle cell neoplasm, the neck was explored, and complete excision of the mass was done. The excisional biopsy turned out to be a classical cervical schwannoma. So this report aims to make physicians aware of the rare case of schwannomas, particularly vagal nerve schwannomas. Clinicians should consider schwannomas in the differential diagnosis of a patient presenting with a cervical mass. Furthermore, they need to be well aware of the diagnostic workup, mainly the imaging modalities, which are essential for proper preoperative planning, surgical treatment, and postoperative complications of cervical schwannomas.

Schwanoma of the cervical sympathetic chain: A case report

“…They may also experience tingling and numbness near nerve distribution. They should be alerted to malignant tumors if there is neurologic deficit [ 12 ]. Schwannomas rarely interfere with nerve activity, and nerve injury is rare due to the cervical sympathetic chain's free fascial compartment.…”

“…The most used diagnostic techniques for schwannomas include computed tomography (CT), MRI, ultrasonography, and fine-needle aspiration cytology (FNAC). Magnetic resonance imaging (MRI) is the best imaging technique for thorough investigation, such as determining the nerve of origin and detecting vascular linkages, which are essential for preoperative planning [ 12 , 15 , 16 ].…”

Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

“…Because of its rarity and lack of neurological deficit as a presenting symptom, preoperative consideration of schwannomas is very difficult. Several differential diagnoses may be entertained for neck tumors, including metastatic cervical lymphadenopathy, submandibular salivary gland tumors, inflammatory cervical lymphadenopathy, carotid body tumors, neurofibroma, lipomas, thyroid cysts or nodules, teratoma or brachial cysts [ 14 ].…”