Endocrine Abstracts (2008) 16 P275

Nerve vagus schwannoma

Adem Karatas1, Mete Duren1, Kagan Karabulut1, Husrev Hatemi2, Guler Turkes Ateş2 & Serdar Giray2


1Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey; 2Universal Hospitals Group Das Deutsche Krankenhaus, Istanbul, Turkey.


Introduction: Schwannomas are benign, encapsulated, solitary, slow-growing tumors which originate from nerve sheath cells in cranial, periferic, symphathetic nerve system. Aproximately, 25–45% of schwannomas are in head and neck region. N. Vagus Schwannoma are seen relatively, rarely. The patients frequently apply with a slow-growing, painless servical mass. Malign transformation is unusual.

Case report: The patient 37 years old applied to our clinic because of mass on his neck.In his history, it was applied lymphadenopathy excision when he was 11 years old and it was applied servical radiotherapy because his pathology result showed Hodgkin lymphoma. The thyroid function tests were normal. It was found a colloidal nodul 4 cm in the right thyroid lobe and a 2 cm lymphadenopathy lateral to the right lobe in the neck ultrasonography. The result of fine needle biopsy that was applied from right thyroid lobe was evaluated as follicular neoplasm. It couldnot diagnose with fine needle biopsy from the mass that was in the right lateral neck. It was performed bilateral total thyroidectomy to the patient and It was performed excisional biopsy from the mass because of the close relationship with nerve vagus in the mass of right neck. At histopathologic examination it was found schwannoma in the nerve vagus and thyroid follicular adenoma. It wasnot attempt again because the mass was asemptomatic and had a close relationship with nerve vagus. The patient who doesnot have any complaint is still observed.

Discussion: It was found frequently in the vestibular nerve (acustic neuroma). The most of patients are between 20–50 years old. it was more common on women. Nerve Vagus Schwannomas are relatively less common. İt can be used fine needle biopsy and magnetic resonance imaging. The treatment is excision of the mass by protecting the nerve vagus. Nerve continuity can protect by mycrosurgical technique which was described by Fujino et al. In patients that underwent incomplete resection or have surgical contraindication the alternative cure methods are radiotherapy and sterotactic radio-surgery. The risk of malign transformation is extremely rare. The patient with Von Recklinghausen disease develop a malignant schwannoma in 3–13% of case but never before 10–20 year latent period. So the patients should be observed.

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