Aregawi Alazar Berhe
Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia.
Int Med Case Rep J. 2023 Mar 11;16:141-151. doi: 10.2147/IMCRJ.S401858. eCollection 2023.
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.
神经鞘瘤是一种生长缓慢的良性肿瘤，起源于施万细胞。神经鞘瘤在男女中发病率相同。它可发生于任何年龄组，但大多数病例出现在30至50岁之间。约四分之一至三分之一的颅外神经鞘瘤病例起源于头颈部区域。迷走神经是颈部区域最主要的起源部位，其次是颈交感神经链。大多数神经鞘瘤患者无症状。颈部迷走神经鞘瘤患者主要表现为声带麻痹导致的声音嘶哑。由于其罕见性且缺乏作为首发症状的神经功能缺损，术前对神经鞘瘤的考虑较为困难，可能会有多种鉴别诊断。迷走神经鞘瘤的主要治疗方法是完整手术切除。在此，我们报告一例来自埃塞俄比亚的30岁男性农民的罕见颈迷走神经鞘瘤病例。患者出现颈部逐渐增大的肿块，病程10年。在就诊前5个月开始出现声音嘶哑。检查时，他有巨大的颈部前方肿块。他有两次细针穿刺抽吸活检（FNAC）结果均不明确，并进行了颈部CT检查。考虑到多结节性甲状腺肿与梭形细胞瘤，对颈部进行了探查，并完整切除了肿块。切除活检结果为典型的颈神经鞘瘤。因此，本报告旨在让医生了解神经鞘瘤的罕见病例，特别是迷走神经鞘瘤。临床医生在鉴别诊断颈部肿块患者时应考虑神经鞘瘤。此外，他们需要充分了解诊断检查，主要是成像方式，这对于颈神经鞘瘤的正确术前规划、手术治疗和术后并发症至关重要。
