VAGAL NERVE SCHWANNOMA IN A YOUNG MALE PATIENT MISDIAGNOSED AS A THYROID NODULE markogiannakis@yahoo.com

PW06-08

VAGAL NERVE SCHWANNOMA IN A YOUNG MALE PATIENT MISDIAGNOSED AS A THYROID NODULE

8

 

 

 

 

Greece

Oral or Poster

Schwannomas are rare neural sheath neoplasms arising from Schwann cells.

A vagal nerve schwannoma case in a young man misdiagnosed as a thyroid nodule is presented.

A 35-year-old man with free history presented with a painless palpable right cervical mass which had increased rapidly during the last months. Thorough clinical examination, laboratory investigation and laryngoscopy were normal. Neck ultrasound, CT and MRI revealed a 6x5x5cm tumor with close proximity to the right thyroid lobe, the common carotid artery and internal jugular vein. Two US-guided FNAs were performed that were both unsuccessful (Bethesda I). Most likely diagnosis was that of a thyroid nodule. Consequently, surgical cervical exploration with a plan of thyroidectomy was scheduled. Surprisingly, it was intraoperatively identified that the tumor was very close but separated from the normal thyroid lobe whereas it originated from the right vagus nerve. A small neoplasm piece was received for biopsy and the tumor was not resected. Histopathology and immunohistochemistry examination reported the diagnosis of a benign vagal nerve schwannoma (Ki-67 ≤2%, S100+). During the 7-year follow-up period the patient is well, asymptomatic with a slight increase of the tumor size.

Vagal schwannomas are rare, usually benign neoplasms that present as a painless cervical mass. Diagnosis is based on clinical and radiological suspicion and is proven by pathology examination of a specimen received by true-cut/core biopsy or surgery. Conservative treatment or surgical excision constitute the two therapy options. A multidisciplinary team approach is desirable to develop a tailored treatment plan for these challenging cases.