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Challenges in managing a vagal schwannomas: Lesson learnt

BACKGROUND: Paraganglioma of head and neck is a rare tumor and vagal schwannoma is even rarer. The majority of patients with vagal schwannoma presents with a lateral neck mass. Its management is delicate as the need to confirm the diagnosis by histopathology via a biopsy is contraindicated. Here, is...

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Autor principal: Mat Lazim, Norhafiza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203238/
https://www.ncbi.nlm.nih.gov/pubmed/30366175
http://dx.doi.org/10.1016/j.ijscr.2018.10.025
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author Mat Lazim, Norhafiza
author_facet Mat Lazim, Norhafiza
author_sort Mat Lazim, Norhafiza
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description BACKGROUND: Paraganglioma of head and neck is a rare tumor and vagal schwannoma is even rarer. The majority of patients with vagal schwannoma presents with a lateral neck mass. Its management is delicate as the need to confirm the diagnosis by histopathology via a biopsy is contraindicated. Here, is a case of a young female with vagal schwannoma complicated with hoarseness after the biopsy of the mass, which persists after extirpation of the tumor. CASE DESCRIPTION: A 22-year old lady presented with a history of a right neck mass for a 5-months duration. Clinical examination revealed a mass at level II neck region which measures 3.0 cm × 2.0 cm and it was mobile, non-pulsatile and had smooth surfaced. CT scan and angiogram showed that the mass arose between the carotid artery and vagal nerve and it was a highly vascular lesion. A CT scan-guided biopsy performed but complicated with neck hematoma and patient developed hoarseness. On follow up, her hoarseness persists and her tissue biopsy came back as schwannoma. She was counseled regarding surgery versus radiation for her treatment and she agreeable for surgery. Hence, surgical excision was performed and intraoperatively the mass visualized arising from the vagal nerve. Postoperatively however, her voice did not improve. CONCLUSION: Vagal schwannoma is a rare paraganglioma of head and neck and the best treatment is still controversial. Unnecessary investigation and procedure should be avoided in order to reduce morbidity as well as improves patient’s quality of life.
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spelling pubmed-62032382018-10-30 Challenges in managing a vagal schwannomas: Lesson learnt Mat Lazim, Norhafiza Int J Surg Case Rep Article BACKGROUND: Paraganglioma of head and neck is a rare tumor and vagal schwannoma is even rarer. The majority of patients with vagal schwannoma presents with a lateral neck mass. Its management is delicate as the need to confirm the diagnosis by histopathology via a biopsy is contraindicated. Here, is a case of a young female with vagal schwannoma complicated with hoarseness after the biopsy of the mass, which persists after extirpation of the tumor. CASE DESCRIPTION: A 22-year old lady presented with a history of a right neck mass for a 5-months duration. Clinical examination revealed a mass at level II neck region which measures 3.0 cm × 2.0 cm and it was mobile, non-pulsatile and had smooth surfaced. CT scan and angiogram showed that the mass arose between the carotid artery and vagal nerve and it was a highly vascular lesion. A CT scan-guided biopsy performed but complicated with neck hematoma and patient developed hoarseness. On follow up, her hoarseness persists and her tissue biopsy came back as schwannoma. She was counseled regarding surgery versus radiation for her treatment and she agreeable for surgery. Hence, surgical excision was performed and intraoperatively the mass visualized arising from the vagal nerve. Postoperatively however, her voice did not improve. CONCLUSION: Vagal schwannoma is a rare paraganglioma of head and neck and the best treatment is still controversial. Unnecessary investigation and procedure should be avoided in order to reduce morbidity as well as improves patient’s quality of life. Elsevier 2018-10-19 /pmc/articles/PMC6203238/ /pubmed/30366175 http://dx.doi.org/10.1016/j.ijscr.2018.10.025 Text en © 2018 The Author http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mat Lazim, Norhafiza
Challenges in managing a vagal schwannomas: Lesson learnt
title Challenges in managing a vagal schwannomas: Lesson learnt
title_full Challenges in managing a vagal schwannomas: Lesson learnt
title_fullStr Challenges in managing a vagal schwannomas: Lesson learnt
title_full_unstemmed Challenges in managing a vagal schwannomas: Lesson learnt
title_short Challenges in managing a vagal schwannomas: Lesson learnt
title_sort challenges in managing a vagal schwannomas: lesson learnt
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203238/
https://www.ncbi.nlm.nih.gov/pubmed/30366175
http://dx.doi.org/10.1016/j.ijscr.2018.10.025
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