Schwannoma neck: a diagnostic dilemma


  • Babu Manohar Department of ENT and Head and Neck Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
  • Raees Abdurahiman Department of ENT and Head and Neck Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India



Schwannoma, Recurrent laryngeal nerve, Thyroid gland


Schwannomas are less common benign slow growing tumors originating from Schwann cells. In the head and neck region, schwannomas arise most commonly from the vagus nerve or the sympathetic chain. We present this case as the location of schwannoma is extremely rare and due to the diagnostic difficulties it posed. A 48 year old male presented with right neck swelling and breathing difficulty to our OPD. Patient underwent ultrasonogram of neck, MRI neck and Fine needle aspiration cytology (FNAC) of the lesion. Each of the investigations suggested different pathology which made the diagnosis challenging. During surgery, the lesion was found to arise from right recurrent laryngeal nerve. After excision of the lesion, the patient developed hoarse voice and the pathological examination revealed schwannoma. Schwannomas that originate from Schwann cells can affect any part of the body. MRI, CT, USG and FNAC have been suggested in the literature for diagnosing the lesion. Trucut biopsy should be considered in situations where FNAC becomes inconclusive. Surgical excision is the treatment of choice. Histologically, five variants of schwannomas have been described in the literature namely common, plexiform, cellular, epithelioid and ancient schwannoma. To conclude, schwannoma arising from RLN which masqueraded as a thyroid swelling is a rare entity. The diagnostic modalities suggested in the literature were unable to pin point the diagnosis. Once, FNAC shows an inadequate specimen, a trucut biopsy should be considered as the next investigation modality.


Dhar H, Dabholkar JP, Kandalkar BM, Ghodke R. Primary thyroid schwannoma masquerading as a thyroid nodule. J Surg Case Rep. 2014;9:rju094.

Pillai S, Agarwal AC, Mathew M, Nayak DR. Ancient schwannoma mimicking a thyroid mass with retrosternal extension. BMJ Case Rep. 2013;2013:bcr2013200608.

Kim SH, Kim NH, Kim KR, Lee JH, Choi HS. Schwannoma in Head and Neck: Preoperative Imaging Study and Intracapsular Enucleation for Functional Nerve Preservation. Yonsei Med J. 2010;51:938-42.

Behuria S, Rout TK, Pattanayak S. Diagnosis and Management of Schwannomas Originating from the Cervical Vagus Nerve. Ann R Coll Surg Engl. 2015;97:92–7.

Satarkar RN, Kolte SS, Vujhini SK. Cystic schwannoma in neck: fallacious diagnosis arrived on fine needle aspiration cytology. Diagn Cytopathol. 2011;39:866–7.

Ku HC, Yeh CW. Cervical schwannoma: a case report and eight years review. J Laryngol Otol. 2000;114:414–7.

Irabor DO, Ladipol JK, Nwachokor FN, Thomas JO. Schwannoma of the left brachial plexus mimicking a cervicomediastinal goiter in a young Nigerian lady. West Afr J Med. 2002;21:195–6.

Chang SC, Schi YM. Neurilemmoma of the vagus nerve. A case report and brief literature review. Laryngoscope. 1984;94:946–9.

Bayindir T, Kalcioglu MT, Kizilay A, Karadag N, Akarcay M. Ancient schwannoma of the parotid gland: a case report and review of the literature. J Craniomaxillofac Surg. 2006;34:38–42.

Gibber MJ, Zevallos JP, Urken ML. Enucleation of Vagal Nerve Schwannoma Using Intraoperative Nerve Monitoring. Laryngoscope. 2012;122:790–2.