A Report on a Case and Literature Review on Cervical Sympathetic Chain Schwannoma that Mimics a Paraganglioma

Abstract

Background: Cervical sympatric schwannoma is a rare benign tumor originating from de Schwan cells. Its clinical presentation is misleading and it can remain asymptomatic for a long time. Mostly, it appears as slow slow-growing cervical mass and may be a differential diagnosis with other neck masses such as paragangliomas. We discuss a case of Cervical sympatric schwannoma and go over its radiological, surgical, and surgical characteristics. Case Presentation: With no prior medical history, a 61-year-old lady appeared with a right cervical mass that had been present for over two years but had lately grown in size without causing dysphagia, dysphonia, or dyspnea. Clinical examination found a firm, slightly pulsatile, non-painful latero-cervical mass measuring 2 × 3 cm. Without other abnormalities on examination of the upper aerodigestive tract or thyroid gland and no neurological deficit. Cervical Ultrasound showed an oval tissular mass with regular contours in close contact with the right common carotid artery. Computed Tomography showed a right superior jugulocarotid mass located behind the vascular axis of the neck with early central vascularization. On magnetic resonance imaging (MRI), this mass was well limited, hypointense on T1 and hyper-intense on T2 with intense contrast enhancement, corresponding to a paraganglioma or schwannoma. A full blood work came back negative. Our patient underwent a complete surgical excision of the tumour which originated in the deep branches of the cervical plexus. Following surgery, the patient had Horner’s syndrome, histopathology confirmed the diagnosis of schwannoma. Conclusions: It is still challenging to differentiate between cervical sympathetic chain schwannoma and paraganglioma clinically and radiological. In the case of the schwannoma surgical approaches must be as conservative as possible to avoid damages of the origin nerve and the patient must be aware of the possibility of Horner syndrome.