Ancient Schwannoma of the Cervical Sympathetic Chain : A Case Report
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Ancient Schwannoma of the Cervical Sympathetic Chain : A Case Report
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Primuharsa Putra Sabir Husin Athar, Norleza Ahmad Norhan, Megat Shiraz Megat Abdul Rahman
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The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Ancient Schwannoma of the Cervical Sympathetic Chain : A Case Report
Year: 2007
Copyright (license): CC BY 4.0
Summary of article contents:
Introduction
Ancient schwannoma of the cervical sympathetic chain is an exceedingly rare nerve tumor, with an estimated occurrence of only a few reported cases. This report presents a 41-year-old female who had a 20-year history of an asymptomatic swelling in the parapharyngeal space, eventually leading to diagnosis and surgical excision of the tumor. Clinical examination and computed tomography indicated displacement of the carotid artery, which provided insight into the tumor's origin. Histological examination post-surgery confirmed the presence of an ancient schwannoma, which is characterized by spindle cells and distinct cellular changes.
Characteristics of Ancient Schwannoma
Ancient schwannomas, while benign, present unique microscopic features that differentiate them from other tumors. These tumors exhibit a mixture of cellular patterns, notably a compact area with palisading nuclei (Antoni A pattern) and a more loosely arranged hypocellular region (Antoni B pattern). In the case of ancient schwannomas, degeneration may result in bizarre, hyperchromatic nuclei, but these tumors typically lack mitotic figures. The diagnosis often relies on immunohistochemical assays, which in this case demonstrated positivity for S100 and Vimentin, identifying the tumor's nerve origin. The presence of Horner's syndrome, which can develop due to cervical sympathetic chain involvement, was notably observed postoperatively, indicating the close association of the tumor with crucial nerves.
Conclusion
Surgical excision remains the primary treatment for cervical schwannomas, although preserving nerve function can be challenging due to the tumors being closely intertwined with surrounding structures. In this report, the surgical approach involved careful dissection to remove the tumor from the cervical sympathetic chain. The patient displayed postoperative Horner's syndrome, a known complication of such surgeries, which may resolve over time. This case underlines the significance of imaging studies in preoperative planning and emphasizes the complex nature of diagnosing and treating ancient schwannomas, particularly those arising from the cervical sympathetic chain.
FAQ section (important questions/answers):
What is an Ancient Schwannoma and where does it occur?
Ancient Schwannoma is a rare benign nerve tumor, often found in the head and neck. It arises from schwann cells along nerves, typically appearing as a solitary mass. Schwannomas of the cervical sympathetic chain are particularly uncommon.
What symptoms did the patient in this case report present?
The 41-year-old female had a 20-year history of a painless neck swelling that gradually increased in size. She experienced no symptoms of dysphagia, hoarseness, or weakness, but upon examination, a mass was noted in the right parapharyngeal space.
How was the diagnosis of Ancient Schwannoma confirmed in this case?
The diagnosis was confirmed through histological examination revealing spindle cells and bizarre nuclei, combined with immunohistochemical assays that showed positivity for S100 and Vimentin, typical indicators of schwannoma.
What surgical intervention was performed for the patient's schwannoma?
The surgery involved complete excision of the mass after careful dissection from surrounding structures. Despite efforts to preserve nerve function, post-operative examination revealed Horner's syndrome, indicating nerve involvement during the procedure.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Ancient Schwannoma of the Cervical Sympathetic Chain : A Case Report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Swelling:
Swelling refers to the unusual mass found in the patient’s right parapharyngeal space. This asymptomatic solitary mass, developed over 20 years, is significant in diagnosing the condition, as it indicates the presence of a potential nerve tumor like schwannoma originating from the cervical sympathetic chain.
2) Wall:
The term wall describes the lateral pharyngeal wall, which was pushed medially by the mass. This displacement is essential in the clinical examination and imaging of the tumor, indicating that the growth of the schwannoma affects surrounding structures, thus aiding in the diagnosis and understanding of the tumor's behavior.
3) Reflecting:
Reflecting in the context of this case refers to the cellular changes observed in the ancient schwannoma's histological examination. The bizarre, hyperchromatic nuclei indicate degeneration, reflecting the tumor's age and potential previous developmental stages, which are characteristic of schwannomas and critical for understanding tumor pathology.
4) Incision:
Incision refers to the surgical approach taken to access the mass. A cervical incision was made, highlighting the importance of surgical intervention in treating schwannomas. The method of incision impacts the extent of exposure, nerve identification, and the overall potential for preserving nerve function during tumor excision.
5) Silver:
Silver refers to one of the authors, DJ Silver, who contributed to research on schwannomas of the cervical sympathetic chain. The mention of authors supports the credibility of the findings presented in the report. It emphasizes the collaborative nature of scientific research and the importance of peer contributions in the medical literature.
6) Pulse:
Pulse describes the carotid pulse identified during the examination, which was palpated after the mass displaced it antero-medially. This finding indicates the mass's proximity to critical vascular structures, providing insight into the tumor's location and potential complications, particularly concerning vascular involvement during surgical planning.
7) Post:
Post refers to the postoperative observation of right-sided Horner’s syndrome in the patient. This finding signifies possible surgical complications or nerve damage following the excision of the schwannoma. It is relevant for clinical monitoring and emphasizes the importance of careful surgical techniques to mitigate adverse effects on nerve function.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Ancient Schwannoma of the Cervical Sympathetic Chain : A Case Report’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Clinical examination, Surgical treatment, Surgical excision, Case report, Nerve injury, CT scan, Histological examination, Vagus Nerve, Hypoglossal Nerve, Accessory Nerve, Computed tomography, Horner's syndrome, Postoperative period, Benign tumor, Fine needle aspiration, Spindle cells, Immunohistochemical assay, Salivary gland tumors, Cranial nerve palsies, Slow growing, Schwann cell, Surgical planning, Cranial nerve, Carotid artery, Jugular Vein, Parapharyngeal space, Soft tissue mass, Cervical sympathetic chain, Ancient Schwannoma, Peripheral nerve, Anterior Displacement, Internal carotid artery, Nerve involvement, Preoperative planning, Solitary tumors, Intact capsule, Carotid pulse, Right sided.