Vagal nerve schwannoma--a new diagnostic sign

Fluid-fluid Levels in Musculoskeletal Tumor Imaging

Fluid-fluid levels result from the separation of two fluids of differing densities within a cavernous space with the boundary between the two layers running in a horizontal plane at 90 degrees to the direction of gravity. Magnetic resonance imaging is the most sensitive imaging modality to identify fluid-fluid levels. Although the most common bone lesions containing fluid-fluid levels are aneurysmal bone cyst and telangiectatic osteosarcoma, fluid-fluid levels can be observed in a wide variety of bone and soft tissue lesions. Therefore, fluid-fluid levels cannot be considered diagnostic of any particular type of tumor and the diagnosis should be made on the basis of other clinical, radiological and pathological findings. This article summarizes the pathophysiology and imaging characteristics of fluid-fluid levels and discusses the differential diagnosis of tumors with this imaging sign.

Coughing on palpation: A rare complication of vagal schwannoma

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.

Vagus Nerve Schwannoma Mimicking a Lateral Neck Cyst

Schwannomas are benign tumors originating from Schwann cells of the myelin sheath. The cystic appearance of a cervical vagal schwannoma is an extremely rare finding, with few patients reported in the literature. A 60-year-old female patient was seen at our service for a slow-growing, 9 × 6 cm left-sided cystic neck mass. Preoperative clinical and computed tomography evaluation suggested a diagnosis of a lateral neck cyst. The surgical exploration through the lateral cervicotomy revealed a large cystic mass and clearly identified that the tumor was originating from the left vagal nerve. The histopathologic analysis confirmed the diagnosis of schwannoma. Although uncommon, vagal schwannoma with pronounced cystic component should be included in the differential diagnosis of the cystic neck swellings.

Schwannomatosis of Cervical Vagus Nerve

Cervical vagal schwannoma is a rare entity among lesions presenting as a neck mass. They are usually slow-growing benign lesions closely associated with the vagus nerve. They are usually solitary and asymptomatic. Multiple schwannomas occurring in patients without neurofibromatosis (NF) are rare and have recently been referred to as schwannomatosis. Here, we present a case of a neck mass that had imaging features suggestive of vagal schwannoma and was operated upon. Intraoperatively, it was discovered to be a case of multiple vagal cervical schwannoma, all directly related to the right vagus nerve, and could be resected from the nerve in toto preserving the function of the vagus nerve. Final HPR confirmed our pre-op suspicion of vagal schwannomatosis.

Two cases of schwannoma with marked cystic changes

We report two cases of schwannoma displaying marked cystic changes; one in the temporalis muscle and one in the submandibular space. The first patient, a 44-year-old male, presented after complaining of a swelling rapidly increasing in size in the left temporal region. Computed tomography (CT) indicated a low-density area surrounded by soft tissue. Magnetic resonance imaging (MRI) revealed signal hypointensity on T1 weighted imaging and strong signal hyperintensity on T2 weighted imaging. The extirpated tumour specimen measured 58 mm x 58 mm x 30 mm. Histopathological examination identified schwannoma, comprising spindle cell proliferation in a palisading pattern with obvious cystic changes. The second case involved a 46-year-old female who presented with swelling of the right submandibular region. Panoramic radiography and lateral oblique mandible projection, which were used together with conventional sialography of the submandibular gland, revealed the so-called "ball in hand" appearance of the submandibular gland, and contrast-enhanced CT identified a lesion of 30 mm diameter with a well-defined annular margin and homogeneous low-density near the tumour centre. Benign pleomorphic adenoma was suspected, but histopathological examination identified schwannoma, predominantly comprising Antoni B type tissue.

Glossopharyngeal schwannoma presenting as gagging dysphagia

A case of cervical glossopharyngeal schwannoma presenting with gagging dysphagia is presented. Treatment was by total excision of the schwannoma following which the patient made a good recovery. To our knowledge, this is the first report of gagging dysphagia associated with a glossopharyngeal schwannoma.