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Tumor Discovery Schwannoma misdiagnosis risks

Whether surgical approach is employed to resect cervical tissue cellularity. In addition to their morphological
11
schwannomas is determined by the location and size of the characteristics, schwannomas can be differentiated from
mass. For instance, accurately identifying location of the leiomyomas and palisaded myofibroblastoma by virtue of
9
mass on vital structures such as neurovascular bundle and their distinctive immunoreactivity profile. Schwannomas
spinal nerve is crucial for decision-making on whether a typically demonstrate diffuse expression of S100 protein,
horizontal or Paul André incision should be employed. In while showing no reactivity for antibody against muscle
3,6
our case, the nerve of origin was not identified. However, markers such as desmin and smooth muscle actin. 12
considering the location of the mass and the ease with Calcification is a rare occurrence in schwannomas. This
which it was dissected from the surrounding structures is supported by a study by Din et al. who identified only
during the surgical exploration, we also believe that the 27 cases of calcifications out of 2116 cases of schwannoma, of
origin was likely a small nerve of the plexus branches. which only three cases were detected in the cervical region.
13
Although the definitive diagnosis relies strictly on Recurrence of schwannoma is exceedingly uncommon, even
histopathologic means, pre-operative imaging proves to in cases where the tumor is incompletely resected. 14
be an essential tool for diagnosing cervical schwannomas.
Imaging can yield crucial information regarding the size 4. Conclusion
and location of the mass, as well as the involvement of Schwannoma should be considered a differential
surrounding structures, such as the neurovascular bundle, diagnosis in patients with a neck mass due to the
and provide guidance in performing a fine need aspiration potential misinterpretation as lymphadenopathy, even
cytology or biopsy (FNAC or FNAB, respectively) through if ultrasonography screening is performed. Radiological
ultrasonography. Both computed tomography (CT) and examinations including CT scan and MRI play an
4,7
magnetic resonance imaging (MRI) findings assist with important role in accurate diagnosis-making as well as pre-
ruling out differential diagnoses such as paraganglioma surgical analysis of anatomical structures.
or congenital cysts. These radiological modalities can also
help identify the nerve of origin by analyzing the mass Acknowledgments
6
effect on the vascular axis. In the case of the involvement None.
of vagus nerve, the tumor tends to widen the space
between the internal carotid or common carotid artery Funding
and the internal jugular vein, whereas the involvement of
8
sympathetic nerve displaces the jugulocarotid axis forward. None.
Ultrasonographic findings alone can be insufficient to Conflict of interest
differentiate between schwannomas and pathologic
lymph nodes, especially since the exploration is operator The authors declare that they have no competing interests.
9
dependent. In a comparative study, Ahn et al. reported
that core needle biopsy (CNB) delivered a high-accuracy Author contributions
performance in diagnosing extracranial schwannomas of Conceptualization: Karmouch Mohamed amine
the head and neck (96.5% specificity and 100% sensitivity), Formal analysis: Karmouch Mohamed amine, Bouzouba
7
as compared to FNAC. However, despite its relatively low Youssef
sensitivity in this respect, FNAC can be used to rule out Investigation: Bouzoubaa Youssef
10
other potential malignant lesions. A FNAC was performed Methodology: Bijou Walid, Rouadi Sami, Mahtar Mohamed
9
in our case guided by ultrasonography showing an atypia Writing – original draft: Karmouch Mohamed Amine
of undetermined significance. Writing – review & editing: Abada Reda allah, Oukessou
Youssef, Roubal Mohamed
While the tumor progression is typically slow,
and malignant transformation is exceptionally rare, Ethics approval and consent to participate
complete excision of the lesion remains the optimal
treatment for symptomatic cervical schwannomas. Written consent was obtained from the patient and his
5,6
Claude-Bernard-Horner syndrome (miosis, ptosis, family to participate in this study.
anhidrosis, and enophthalmos) is the most common Consent for publication
post-operative complication in schwannomas of the
cervical sympathetic chain. This complication can be Written consent was obtained from the patient and
6
confirmed in an anatomopathological examination by his family for the publication of this case report and
identifying spindle cells with Verocay bodies or without accompanying images.

Volume 3 Issue 2 (2024) 3 doi: 10.36922/td.2606