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Case Reports
. 2021 Jul 27:68:102624.
doi: 10.1016/j.amsu.2021.102624. eCollection 2021 Aug.

Schwannoma of the sympathetic trunk: A case report

Basel Al-Ghotani  1 , Bana Abo-Shdeed  1 , Areej Alassaf  1   2
Affiliations
Case Reports

Schwannoma of the sympathetic trunk: A case report

Basel Al-Ghotani et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Schwannomas are benign tumors commonly found in the cranial vault at the cerebellopontine angle. Schwannomas could arise from any nerve that has Schwann sheath. Their most common extra-cranial localization is the parapharyngeal space. Schwannomas do not usually metastasize, and recurrence is uncommon.

Case presentation: We present a case of a sympathetic trunk schwannoma in a patient that presented with dysphagia and a painful neck mass. Oro-pharyngeal examination revealed the presence of a mass filling-up the left tonsillar fossa, and pushing the uvula to the right side. The larynx was also deviated to the right due to the mass effect. The mass was resected en-bloc with the involved part of the sympathetic trunk. The patient developed Horner's syndrome postoperatively.

Clinical discussion: The occurrence of Sympathetic trunk Schwannomas is very rare. The majority of patients presented with a cervical mass and non-specific symptoms. The most effective treatment is surgical resection. Our experience suggests sympathetic trunk Schwannomas as a differential diagnosis of slow-growing neck masses and asserts that the surgical resection is the main treatment.

Conclusion: The occurrence of Schwannomas in the sympathetic trunk is rare. High clinical suspicion is required to achieve the preoperative diagnosis. The optimal management is the total surgical resection. Recurrence is uncommon when the mass is totally resected.

Keywords: CT scan, Computed tomography scan; Case report; MRI, magnetic resonance imaging; Neck tumors; Neurilemmomas; Schwannoma; Sympathetic trunk; US, ultrasound.

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Conflict of interest statement

All the authors declared that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging of the head and neck demonstrating the localization of the mass in the parapharyngeal space. A, B: T1-weighted MRI. C: T2-Weighted MRI.
Fig. 2
Fig. 2
The sympathetic trunk Schwannoma in situ. Note the close involvement with the sympathetic trunk.
Fig. 3
Fig. 3
A) Hyalinized stroma with variably sized ectatic blood vessels (Hematoxylin and eosin stain × 40), B) Cellular area alternating with hypocellular areas (Hematoxylin and eosin stain × 40). C) Cellular areas showing nuclear palisading and verocay bodies (Hematoxylin and eosin stain × 200), D) Diffuse and strong positive immunoreactivity for S100 (immunohistochemically, × 100).
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