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. 2017 Jul;6(4):216-220.
doi: 10.1159/000454877. Epub 2017 Jan 21.

A Cervical Schwannoma Masquerading as a Thyroid Nodule

Sravanthi Nagavalli  1 , Marelle Yehuda  1 , Laron W McPhaul  2 , Andrew G Gianoukakis  1
Affiliations

A Cervical Schwannoma Masquerading as a Thyroid Nodule

Sravanthi Nagavalli et al. Eur Thyroid J. 2017 Jul.

Abstract

Background: We present a case of a cervical schwannoma, likely originating from the pharyngeal plexus of the vagal nerve. The lesion masqueraded as a thyroid nodule and magnetic resonance imaging (MRI) assisted in preoperative diagnosis. We review the radiographic characteristics of nerve sheath tumors on MRI as well as the diagnostic cytologic stains which can enhance the possibility of a correct preoperative diagnosis.

Case: We describe a 60-year-old female with dysphagia and a neck mass consistent with a nodular goiter. The patient's history, diagnostic images, cytology, pathology, and surgical management are presented and analyzed. The preoperative diagnosis of a cervical schwannoma was suspected by the use of MRI which led to additional specialized cytologic stains.

Conclusion: Pharyngeal wall schwannomas are important to consider in the differential diagnosis of thyroid nodules when fine needle aspiration cytology indicates cells of neural origin. Imaging by MRI can assist in identifying lesions of neural origin masquerading as thyroid nodules.

Keywords: Magnetic resonance imaging; S-100; Schwannoma; Thyroid nodule.

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Figures

Fig. 1
Fig. 1
Transverse ultrasound image. Hypoechoic mass with smooth borders, which appears intrinsic to the thyroid.
Fig. 2
Fig. 2
Imaging: contrast-enhanced computed tomography(a,b) and magnetic resonance imaging (c, d). a Axial image demonstrates diffusely enlarged thyroid. a, b Heterogeneous appearance of right and left lobes characteristic of multinodular goiter. b Coronal image demonstrates lesional extension to the anterior mediastinum. c Axial T2-weighted image demonstrates hyperintense left thyroid bed lesion. d Enhanced axial T1-weighted image demonstrates plane of separation between schwannoma and thyroid goiter (thin arrow).
Fig. 3
Fig. 3
Histology: spindle cells on FNA. a Spindle cells on low power. b Spindle cells on high power. c Spindle cells positive for S-100 (brown, color in online version only).
Fig. 4
Fig. 4
Pathology. a Schwannoma, thyroid and parathyroid tissue. b Hypercellular Antoni A pattern of schwannoma. c S-100 stain positive (brown, color in online version only). d Low proliferation index (Ki67).
See this image and copyright information in PMC

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