Cervical Lymph Node Schwannoma—An Unexpected Diagnosis

Abstract

Introduction:Schwannomas—Schwann cells–originating tumors—may develop in many locations. However, primary schwannomas arising within lymph nodes are extremely rare, with only a few cases described to this date in the English literature. For the intranodal location, most of the cases are described in the abdominal cavity. In these cases, clinicians may consider and check for familial disorders, such as neurofibromatosis type 2 (NF2) and schwannomatosis also called neurofibromatosis type 3. Schwannomas are benign neoplasms. Histologically, differential diagnosis for spindle-cell lesions in lymph nodes is important and must be done carefully, mainly because they may be attributable to metastatic disease. We report a case of a primary schwannoma arising in a cervical lymph node.Background:Primary schwannomas arising within lymph nodes are extremely rare, with only a few cases reported. Since they are benign neoplasms, the differential diagnosis with other intranodal spindle cell lesions, mostly malignant, is important.Methods:An asymptomatic 69-year-old woman, previously submitted to left hemithyroidectomy for a benign folicular nodule, underwent thyroidectomy totalization following the identification of a large thyroid nodule in routine evaluation.Results:Gross and microscopic examination and ancillary studies were consistent with the diagnosis of intranodal schwannoma. The patient had acquired bilateral hypoacusia. Therefore, type 2 neurofibromatosis was considered and vestibular schwannomas ruled out.Conclusion:Herein, we present the second case of a primary schwannoma in a cervical lymph node reported so far. The relevance of the differential diagnosis is highlighted.

A Case of Dedifferentiated Melanoma With Lymph Node Metastasis Where Molecular Biological Tests Were Useful for Diagnosis

“…Among the former, it may be misidentified as spindle cell sarcoma or undifferentiated sarcoma such as undifferentiated pleomorphic sarcoma (UPS) [ 5 , 14 ]. The spindle cell melanoma is misdiagnosed as schwannoma and sometimes as intranodal schwannoma, even if in a lymph node [ 15 ], and can easily be viewed as a false-negative in sentinel lymph node diagnosis [ 5 ].…”

Intranodal Neurofibroma: A Case Report and Literature Review

“…4 For comparison to other nerve sheath tumors, there are 16 reported cases of schwannoma involving the lymph nodes. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Lymph node involvement is considered very uncommon in MPNST unless widely metastatic disease is present. 11,12 Benign granular cell tumor occurring in lymph nodes is described as rare by Enzingar and Weiss.…”

Intranodal palisaded myofibroblastoma expressing DOG1: focusing on the potential diagnostic pitfalls

“…The differential diagnosis list of IPM is wide and includes mostly other spindle cell neoplasms. Schwannomas are circumscribed tumors with spindle cell morphology and nuclear palisading (Verocay bodies) in Antoni A areas and have been reported in lymph nodes, extremely rarely though [ 18 ]. Their strong S100 immunoexpression helps greatly in the differential diagnosis.…”