Abstract
Ancient schwannoma is an uncommon variant of schwannoma, a benign tumor arising from the nerve sheath. It is reported to arise from any nerves except optic and olfactory. However, only six cases of ancient schwannomas arising from ansa cervicalis nerve have been reported to date in English literature. Proper preoperative evaluation is necessary to rule out other causes of neck mass such as thyroid lesions, lymphadenopathy, and carotid body tumor. We report a case of ancient schwannoma arising from the ansa cervicalis nerve. The origin of the lesion from ansa cervicalis was confirmed by intraoperative finding. Postoperative histopathological examination revealed degenerative changes including pleomorphism, cellular atypia, large nuclei with prominent nucleoli, and paucity of mitotic figures. Periphery of the mass showed nuclear palisading with characteristic verocay bodies. Immunohistochemical evaluation for S-100 showed diffuse positivity of the tumor cells, thereby confirming the diagnosis of schwannoma. We consider that schwannoma of cervical region can have origin from any nerve and should try to identify the origin pre- and intraoperatively. The postoperative complications depend on the nerve of origin and the precision of the surgery performed.
Highlights
Schwannomas are benign tumors arising from nerve sheath, named as neuromas, neurilemmomas, or neurinomas [1, 2]
Schwannoma can arise from all types of nerves except the optic and the olfactory nerves, but schwannoma of the ansa cervicalis is extremely rare and is reported in only six cases to date
Park et al reported a case of schwannoma of ansa cervicalis, but the origin of the schwannoma from ansa cervicalis is confirmed intraoperatively by the contraction of the strap muscles on stimulation [6]. de Diego Sastre et al reported schwannoma originating from ansa cervicalis but the preoperative diagnosis was tumor, arising from thyroid gland [7]
Summary
Schwannomas are benign tumors arising from nerve sheath, named as neuromas, neurilemmomas, or neurinomas [1, 2]. Schwannoma can arise from all types of nerves except the optic and the olfactory nerves, but schwannoma of the ansa cervicalis is extremely rare and is reported in only six cases to date. Because of the rarity of the ansa cervicalis schwannoma, it is seldom considered in the differential diagnosis of schwannoma of the cervical region [1, 2, 4]. The schwannomas arising in the head and neck region mostly originate from the vagus nerve or from the sympathetic nervous system [5]. They usually manifest as a painless mass in the neck with an indolent course and varying pressure symptoms. Surgical excision of the tumor with utmost preservation of the neural function is the accepted treatment for this rare entity [1, 5]
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