Neurofibromas of the Phrenic Nerve: A Case Report and Review of the Literature

Neck schwannoma with phrenic nerve involvement: A rare case report

INTRODUCTION AND IMPORTANCE

Phrenic nerve schwannoma is an occasional axonal tumor that is mostly asymptomatic.

CASE PRESENTATION

In this report, a man with a painless lump in his neck was the subject. His diagnostic process included the recording of schwannoma. Phrenic schwannoma was removed by surgery without any complication during follow-up.

CLINICAL DISCUSSION

Surgical excision under general anesthesia was done for the patient and during the surgical explore, the surgeon observed that, the schwannoma arose from the cervical phrenic nerve. The cervical mass was dissected from the phrenic nerve precisely by intracapsular enucleation technique.

CONCLUSION

The phrenic involvements of schwannomas are extremely rare and mostly presented as a painless mass. Additionally, complete surgical excision of them is an efficient method.

Mediastinal Teratoma Mimicking Neurofibroma in CT-Guided Biopsy in a Patient With Neurofibromatosis Type 1

Teratomas are a type of germ cell tumor that may contain several different types of tissue. Neurofibroma is a benign peripheral nerve sheath tumor with the plexiform type being pathognomonic for neurofibromatosis type 1. We report a case of a 33-year-old woman with a background of Neurofibromatosis type 1 who presented with left-sided chest pain and shortness of breath. She was diagnosed with a large mediastinal mass which was confirmed from a CT-guided biopsy as neurofibroma. Following a multidisciplinary team discussion, she underwent mediastinal mass resection and the final histopathology report revealed mediastinal mature teratoma.

Phrenic nerve schwannoma as an incidental intraoperative finding. Case report

Introduction and importance

Peripheral neuronal sheath tumors are rare lesions that can arise from the lining of the neuronal axons of any nerve in the body. Schwannomas are usually solitary and encapsulated, slow growing, predominantly benign, with a malignant transformation rate of less than 2% and very low recurrence. The phrenic nerve schwannoma is rare in the neck and usually is asymptomatic.

Case presentation

We present a case of a phrenic nerve schwannoma as an incidental intraoperative finding in the study of a patient with a cervical mass of progressive growth on the right side of the neck in contact with the anterior scalene muscle and pain intermittent. Resection of the mass was done with preservation of the endoneurium. Intraoperative stimulation after resection had a proper functionality of the phrenic nerve. In the follow-up, the patient had not any damage of the function of the phrenic nerve.

Clinical discussion

This tumor is generated by a deficiency of merlin with the consequent cell proliferation. The diagnostic imaging (CT or MRI) are the studies of choice. The differential diagnosis of these lesions has an impact on the presence or absence of oncological disease or progression of a previously treated one. The ideal management is surgical and the anatomical and/or functional preservation of the nerve depend of the tumor infiltration.

Conclusion

The phrenic nerve schwannoma is rare in the neck. The ideal management is surgical, and this pathology must be considered in patients with masses in the Station IV and supraclavicular fossa of the neck.

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Schwannomas are lesions solitary and encapsulated, slow growing, and predominantly benign.

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The phrenic nerve schwannoma is rare in the neck and usually is asymptomatic.

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These are generated by a deficiency of merlin with the consequent cell proliferation.

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CT and MRI are the studies of choice in patients with neck masses and suspicion of schwannoma.

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The anatomical and functional preservation of the nerve depends on tumor infiltration.

Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case

Schwannomas are benign tumours that originate from the myelin sheath of peripheral nerves. They are characterised by a slow growth tendency. Benign schwannomas represent 35% of the head and neck district tumours. Hypoglossal schwannomas account for 5% of non-vestibular schwannomas, and malignant schwannomas occur very rarely. In the present case report, the case of a 49-year-old man who presented with paraesthesias in the left parotid and submandibular region, associated with sensation of foreign bodies and dysphagia for solids, is described. A clinical examination revealed the presence of an ovoid palpable mass in the lateral-cervical region of the neck. The patient subsequently underwent excisional surgery, and neuropathological evaluation of the specimen confirmed the diagnosis of benign schwannoma with Antoni areas A and B. Despite the rarity of schwannomas, this condition should be considered in differential diagnoses for masses localised in the neck, as in cases where they reach considerable sizes (>3 cm in diameter). Surgery therefore represents the first-choice treatment.