European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 115–116
Available online at
ScienceDirect www.sciencedirect.com
Letter to the Editor Unusual retropharyngeal mass Tuméfaction rétropharyngée inhabituelle Schwannoma is a benign mesenchymal tumour arising from Schwann cells of the nerve sheath of peripheral nerves. It is characterized by a long clinical latency and a late and difficult diagnosis. Assessment of the lesions and differential diagnosis is based on CT and MRI. The authors report a case of schwannoma of the cervical plexus with an unusual clinical expression. A 16-year-old boy, with no notable history, presented with sudden onset of swollen neck causing respiratory discomfort, dysphagia to solids, but no dysphonia, evolving in a context of apyrexia. Clinically, the patient was breathless, but with no signs of respiratory distress, with a hard, painful, mobile left lateral neck swelling, measuring 6 × 3 cm, with torticollis and swelling of the posterior wall of the oropharynx. Neck CT scan revealed a retropharyngeal collection measuring 11.5 × 8.7 × 6.2 cm, possibly corresponding to an abscess (Fig. 1). Emergency surgical exploration was therefore performed, revealing a solid mass in the left lateral and retropharyngeal space with haematoma. Biopsy was performed with drainage and prophylactic tracheostomy. MRI then demonstrated a prevertebral fusiform mass with cystic and solid components, fusing in the retropharyngeal space and measuring 13.7 × 8.7 × 5.2 cm, with a
Fig. 1. CT scan, axial view: Retropharyngeal collection with narrowing of the oropharynx. http://dx.doi.org/10.1016/j.anorl.2015.01.002 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
heterogeneous low-intensity signal on T1-weighted sequences and a high-intensity signal on T2-weighted sequences, with intense contrast enhancement. The mass occupied the oropharynx and nasopharynx, causing lateral displacement of neck vessels (Fig. 2). The patient was then reoperated via a lateral neck incision for resection of the left lateral and retropharyngeal tumour, causing lateral displacement of neck vessels and apparently related to one of the branches of the cervical plexus. Definitive histology confirmed the diagnosis of benign schwannoma. The postoperative course was uneventful, with extubation on postoperative day 15 with no neurological sequelae. Twenty-five to 45% of all schwannomas arise in the head and neck [1]. The neck is less frequently involved and the most common site in the neck is the parapharyngeal space [2]. Schwannoma may be observed at all ages (20 to 70 years) with no sex predominance [3]. It presents in the form of an asymptomatic, isolated, slowly growing lateral neck mass, or, more rarely, sudden onset of compressive signs. Imaging defines the tumour site, shape, size, extension and anatomical relations with neck vessels [4]. Vagus nerve schwannoma enlarges the space between the carotid artery and internal jugular vein, while schwannoma of the sympathetic
Fig. 2. MRI, sagittal view: Prevertebral fusiform mass with solid and cystic components.
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Letter to the Editor / European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 115–116
trunk displaces the neck vessels anteriorly, excluding the diagnosis of vagus nerve schwannoma, which remains the leading differential diagnosis [5]. The diagnosis is based on histological examination with immunohistochemical studies [3]. Treatment is surgical with complete resection of the mass and sacrifice of the nerve in the majority of cases. Schwannoma of the cervical sympathetic trunk is a rare, slowly growing benign tumour, which, despite its atypical clinical features, must be considered on imaging in order to propose appropriate surgical management. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Serhrouchni KI, et al. Two rare schwannomas of head and neck. Diagn Pathol 2014;9(1):27.
[2] Dinesh Kumar Sharma, et al. Schwannomas of head and neck and review of literature. Indian J Otolaryngol Head Neck Surg 2012;64(2):177–80. [3] Naoa EE, et al. Schwannome du sympathique cervical. Ann Fr Otorhinolaryngol Pathol Cervicofac 2012;129:60–3. [4] Anil G, Tan TY. Imaging characteristics of schwannoma of the cervical sympathetic chain: a review of 12 cases. AJNR 2010;31:1408–12. [5] Saito DM, Glastonbury CM, El-Sayed I, Eisele DW. Parapharyngeal space schwannomas. Preoperative imaging determination of the nerve of origin. Arch Otolaryngol Head Neck Surg 2007;133:662–7.
M. Abou-elfadl ∗ S. Lrhazi M. Mahtar M. Roubal Service d’ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, 4, rue Lahcen El Arjoune -ex Dalton, quartier Hôpitaux, 20360 Casablanca, Morocco ∗ Corresponding author. E-mail address: dr abouelfadl [email protected] (M. Abou-elfadl)
Available online at
ScienceDirect www.sciencedirect.com
Letter to the Editor Unusual retropharyngeal mass Tuméfaction rétropharyngée inhabituelle Schwannoma is a benign mesenchymal tumour arising from Schwann cells of the nerve sheath of peripheral nerves. It is characterized by a long clinical latency and a late and difficult diagnosis. Assessment of the lesions and differential diagnosis is based on CT and MRI. The authors report a case of schwannoma of the cervical plexus with an unusual clinical expression. A 16-year-old boy, with no notable history, presented with sudden onset of swollen neck causing respiratory discomfort, dysphagia to solids, but no dysphonia, evolving in a context of apyrexia. Clinically, the patient was breathless, but with no signs of respiratory distress, with a hard, painful, mobile left lateral neck swelling, measuring 6 × 3 cm, with torticollis and swelling of the posterior wall of the oropharynx. Neck CT scan revealed a retropharyngeal collection measuring 11.5 × 8.7 × 6.2 cm, possibly corresponding to an abscess (Fig. 1). Emergency surgical exploration was therefore performed, revealing a solid mass in the left lateral and retropharyngeal space with haematoma. Biopsy was performed with drainage and prophylactic tracheostomy. MRI then demonstrated a prevertebral fusiform mass with cystic and solid components, fusing in the retropharyngeal space and measuring 13.7 × 8.7 × 5.2 cm, with a
Fig. 1. CT scan, axial view: Retropharyngeal collection with narrowing of the oropharynx. http://dx.doi.org/10.1016/j.anorl.2015.01.002 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
heterogeneous low-intensity signal on T1-weighted sequences and a high-intensity signal on T2-weighted sequences, with intense contrast enhancement. The mass occupied the oropharynx and nasopharynx, causing lateral displacement of neck vessels (Fig. 2). The patient was then reoperated via a lateral neck incision for resection of the left lateral and retropharyngeal tumour, causing lateral displacement of neck vessels and apparently related to one of the branches of the cervical plexus. Definitive histology confirmed the diagnosis of benign schwannoma. The postoperative course was uneventful, with extubation on postoperative day 15 with no neurological sequelae. Twenty-five to 45% of all schwannomas arise in the head and neck [1]. The neck is less frequently involved and the most common site in the neck is the parapharyngeal space [2]. Schwannoma may be observed at all ages (20 to 70 years) with no sex predominance [3]. It presents in the form of an asymptomatic, isolated, slowly growing lateral neck mass, or, more rarely, sudden onset of compressive signs. Imaging defines the tumour site, shape, size, extension and anatomical relations with neck vessels [4]. Vagus nerve schwannoma enlarges the space between the carotid artery and internal jugular vein, while schwannoma of the sympathetic
Fig. 2. MRI, sagittal view: Prevertebral fusiform mass with solid and cystic components.
116
Letter to the Editor / European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 115–116
trunk displaces the neck vessels anteriorly, excluding the diagnosis of vagus nerve schwannoma, which remains the leading differential diagnosis [5]. The diagnosis is based on histological examination with immunohistochemical studies [3]. Treatment is surgical with complete resection of the mass and sacrifice of the nerve in the majority of cases. Schwannoma of the cervical sympathetic trunk is a rare, slowly growing benign tumour, which, despite its atypical clinical features, must be considered on imaging in order to propose appropriate surgical management. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Serhrouchni KI, et al. Two rare schwannomas of head and neck. Diagn Pathol 2014;9(1):27.
[2] Dinesh Kumar Sharma, et al. Schwannomas of head and neck and review of literature. Indian J Otolaryngol Head Neck Surg 2012;64(2):177–80. [3] Naoa EE, et al. Schwannome du sympathique cervical. Ann Fr Otorhinolaryngol Pathol Cervicofac 2012;129:60–3. [4] Anil G, Tan TY. Imaging characteristics of schwannoma of the cervical sympathetic chain: a review of 12 cases. AJNR 2010;31:1408–12. [5] Saito DM, Glastonbury CM, El-Sayed I, Eisele DW. Parapharyngeal space schwannomas. Preoperative imaging determination of the nerve of origin. Arch Otolaryngol Head Neck Surg 2007;133:662–7.
M. Abou-elfadl ∗ S. Lrhazi M. Mahtar M. Roubal Service d’ORL et de chirurgie cervico-faciale, hôpital 20-Août-1953, 4, rue Lahcen El Arjoune -ex Dalton, quartier Hôpitaux, 20360 Casablanca, Morocco ∗ Corresponding author. E-mail address: dr abouelfadl [email protected] (M. Abou-elfadl)
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