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Case Reports
. 2020 Oct;81(4):e66-e70.
doi: 10.1055/s-0040-1718408. Epub 2020 Dec 31.

Radiation-Induced Malignant Peripheral Nerve Sheath Tumor of the Vagus Nerve Following Radiation Treatment of Cervical Paraganglioma

Gregory P Lekovic  1 , Gautam U Mehta  1 , Anne K Maxwell  2 , Kevin A Peng  2 , Derald E Brackmann  2
Affiliations
Case Reports

Radiation-Induced Malignant Peripheral Nerve Sheath Tumor of the Vagus Nerve Following Radiation Treatment of Cervical Paraganglioma

Gregory P Lekovic et al. J Neurol Surg Rep. 2020 Oct.

Abstract

Radiation-induced sarcoma is a known but rare complication of radiation treatment for skull base paraganglioma. We present the cases of a female patient with multiple paraganglioma syndrome treated with external beam radiation treatment who presented 4 years later with a malignant peripheral nerve sheath tumor of the vagus nerve.

Keywords: glomus vagale; malignant peripheral nerve sheath tumor; paraganglioma; radiation; radiation-induced sarcoma; vagus nerve.

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Conflict of interest statement

Conflict of Interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this case report.

Figures

Fig. 1
Fig. 1
Preoperative T2-weighted axial ( a ) and coronal ( b ) magnetic resonance imaging of the brain and neck showing a large mass in the carotid sheath with “popcorn”-type appearance of flow voids suggestive of paraganglioma; T1-weighted axial and coronal images following administration of gadolinium demonstrate avid contrast enhancement and splaying of the internal and external carotid arteries ( c and d , respectively).
Fig. 2
Fig. 2
Preoperative anteroposterior ( a ) and lateral ( b ) angiograms show two distinct patterns of vascularity: a prominent blush typical of paraganglioma and an avascular component with pronounced mass effect on the distal carotid artery.
Fig. 3
Fig. 3
Hematoxylin and eosin staining shows two distinct tumors: paraganglioma ( a ) characterized by “zellballen” and a spindle cell neoplasm ( b ). This latter tumor had a high mitotic rate and demonstrated a high K i -67 staining rate (70%) (not shown).
See this image and copyright information in PMC

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