Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer

Ji-Sun Kim; Chang-Young Yoo; Rae-Hyung Kim; Jung-Hae Cho

doi:10.11106/10.11106/jkta.2014.7.1.102

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Kim, Yoo, Kim, and Cho: Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer

Case Report

J Korean Thyroid Assoc 2014;7(1):102-106.

Published online: 7 May 2014

DOI: https://doi.org/10.11106/10.11106/jkta.2014.7.1.102

Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer

Ji-Sun Kim¹, Chang-Young Yoo², Rae-Hyung Kim¹, Jung-Hae Cho¹

Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Suwon, Korea

College of Medicine, The Catholic University of Korea, Department of Pathology, College of Medicine, The Catholic University of Korea, Suwon, Korea

Correspondence: Jung-Hae Cho, MD, Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent Hospital, The Catholic University of Korea, 93-6, Ji-dong, Paldal-gu, Suwon 442-723, Korea Tel: 82-31-249-8306, Fax: 82-31-253-3752, E-mail: jhchomd@catholic.ac.kr

Received 9 December 2013 Accepted 3 February 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of multiple cervical schwannomas mimicking cervical nodal metastasis in a 45-year-old female patient with papillary thyroid carcinoma. Ultrasonography revealed a hypoechoic lesion with irregular contour in the left isthmus of the thyroid gland. A contrast-enhanced CT of the neck showed two wellcircumscribed, cystic masses in the left cervical level II. The preoperative results of ultrasonography guided fine needle aspiration biopsy from both thyroid and lateral neck masses were papillary thyroid cancer and atypical cell, respectively. Considering clinical and imaging results, the lateral neck masses were suspected to be metastatic cervical lymphadenopathy. During surgery, however, we identified that two lateral neck masses were originated from spinal accessory nerve and cervical plexus. The pathologic examination confirmed that lateral neck masses were typical schwannomas. Before surgery, it is important to make every efforts to discriminate metastatic lymphadenopathy from the cystic neck mass in patients with papillary carcinoma.

Keywords: Papillary thyroid carcinoma, Cystic metastasis, Schwannoma, Spinal accessory nerve

References

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Fig. 1.

Preoperative imaging studies. (A) Ultrasonographic image showing an about 0.4×0.6 cm sized hypoechoic nodule with irregular margin in the thyroid isthmus. (B) Ultrasonographic image showing an about 2.5×2.9 cm sized hypoechoic and cystic mass at the left upper lateral neck. (C) Enhanced axial CT image showing well defined two cystic masses (arrows) with heterogeneously enhancement in the cervical level II.

Fig. 2.

Findings of fine needle aspiration cytology. (A) Fine needle aspiration cytology of left isthmic nodule showing nuclear crowding and irregularities of nuclear contours. (B) Fine needle aspiration cytology of left lateral neck mass showing intranuclear inclusion (arrow).

Fig. 3.

The gross findings of surgical specimen. (A) The 2.5×3 cm sized, well encapsulated and yellow mass arising from the spinal accessory nerve. (B) The 1×1.5 cm sized, yellow mass arising from the cervical plexus.

Fig. 4.

Results of histopathology. (A) Histopathological examination of thyroid gland showing papillary growth and ground glass nuclei (H&E stain, ×400). (B) Histopathological examination of lateral neck mass showing compact spindle cells arranged in short and interlacing fascicles (H&E stain, ×200).

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