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Chan K, Keane A, Aynardi J, Choi KY. Phrenic nerve schwannoma presenting as an asymptomatic neck mass. Clin Case Rep 2022; 10:e6784. [PMID: 36590669 PMCID: PMC9794921 DOI: 10.1002/ccr3.6784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022] Open
Abstract
Phrenic nerve schwannomas of the head and neck are exceedingly rare pathologies that can present as an asymptomatic neck mass. Surgery is the definitive treatment, and a conservative surgical approach is preferred if a benign pathology is suspected.
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Affiliation(s)
- Kimberly Chan
- College of MedicineThe Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Allison Keane
- Department of Otolaryngology – Head and Neck SurgeryCollege of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Jason Aynardi
- Department of Pathology and Laboratory MedicineCollege of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Karen Y. Choi
- Department of Otolaryngology – Head and Neck SurgeryCollege of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
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Suárez C, López F, Rodrigo JP, Mendenhall WM, de Bree R, Mäkitie AA, Vander Poorten V, Takes RP, Bondi S, Kowalski LP, Shaha AR, Fernández-Alvarez V, Gutiérrez JC, Zidar N, Chiesa-Estomba C, Strojan P, Sanabria A, Rinaldo A, Ferlito A. Benign Peripheral Non-cranial Nerve Sheath Tumors of the Neck. Adv Ther 2022; 39:3449-3471. [PMID: 35689724 DOI: 10.1007/s12325-022-02191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
Benign peripheral non-cranial nerve sheath tumors are rare lesions, including both schwannomas and neurofibromas. These tumors arise from Schwann cells, and may originate from any peripheral, cranial, or autonomic nerve. Most of them are localized and sporadic but multifocal systemic forms can occur. Cervical sympathetic chain, brachial plexus, cervical plexus and spinal roots and nerves are the major nerve systems commonly affected. Dumbbell-shaped intra- and extradural tumors occur most commonly in the cervical spine, as well as purely extradural and paravertebral tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques and surgical innovations such as endoscopically assisted approaches and robotic surgery. Microsurgical intracapsular excision of the tumor helped by the use of intraoperative fluorescent dyes and intraoperative neurophysiological monitoring minimize postoperative neural deficit, since most schwannomas are encapsulated. Most tumors can be removed with a low rate of complications and recurrence. Radiotherapy should be considered for growing lesions that are not amenable to surgery. In asymptomatic patients, observation and serial scans is an option for elderly infirm patients.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefano Bondi
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and University of São Paulo Medical School, São Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Julio C Gutiérrez
- Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastián, Spain
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, 050010, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, 050021, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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García RLB, Jimenez J, Vargas N, Granados Á. Phrenic nerve schwannoma as an incidental intraoperative finding. Case report. Int J Surg Case Rep 2022; 91:106783. [PMID: 35101715 PMCID: PMC8804164 DOI: 10.1016/j.ijscr.2022.106783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Peripheral neuronal sheath tumors are rare lesions that can arise from the lining of the neuronal axons of any nerve in the body. Schwannomas are usually solitary and encapsulated, slow growing, predominantly benign, with a malignant transformation rate of less than 2% and very low recurrence. The phrenic nerve schwannoma is rare in the neck and usually is asymptomatic. Case presentation We present a case of a phrenic nerve schwannoma as an incidental intraoperative finding in the study of a patient with a cervical mass of progressive growth on the right side of the neck in contact with the anterior scalene muscle and pain intermittent. Resection of the mass was done with preservation of the endoneurium. Intraoperative stimulation after resection had a proper functionality of the phrenic nerve. In the follow-up, the patient had not any damage of the function of the phrenic nerve. Clinical discussion This tumor is generated by a deficiency of merlin with the consequent cell proliferation. The diagnostic imaging (CT or MRI) are the studies of choice. The differential diagnosis of these lesions has an impact on the presence or absence of oncological disease or progression of a previously treated one. The ideal management is surgical and the anatomical and/or functional preservation of the nerve depend of the tumor infiltration. Conclusion The phrenic nerve schwannoma is rare in the neck. The ideal management is surgical, and this pathology must be considered in patients with masses in the Station IV and supraclavicular fossa of the neck. Schwannomas are lesions solitary and encapsulated, slow growing, and predominantly benign. The phrenic nerve schwannoma is rare in the neck and usually is asymptomatic. These are generated by a deficiency of merlin with the consequent cell proliferation. CT and MRI are the studies of choice in patients with neck masses and suspicion of schwannoma. The anatomical and functional preservation of the nerve depends on tumor infiltration.
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Affiliation(s)
- Rogers Leonardo Baquero García
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia.
| | - Julián Jimenez
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Nathalie Vargas
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Álvaro Granados
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
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Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings. Neurol Clin Pract 2019; 10:415-421. [PMID: 33299669 DOI: 10.1212/cpj.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/25/2019] [Indexed: 01/15/2023]
Abstract
Objective We evaluated the performance of ultrasound in the detection of neuropathy of the suprascapular nerve (SSN), long thoracic nerve (LTN), spinal accessory nerve (SAN), and phrenic nerve and compared this performance with MRI. Methods A retrospective review of 56 patients who had undergone ultrasound imaging of the SSN, LTN, SAN, and phrenic nerve was performed. Diagnoses made by ultrasound, MRI, EMG reports, and clinical and operative notes were recorded. Results Ultrasound was successful in visualizing nerves in the neck in the overwhelming majority of cases. Sonographic findings were typically in agreement with MRI and clinical findings. Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck.
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Affiliation(s)
- Emily Casaletto
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Bin Lin
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Scott W Wolfe
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Steve K Lee
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Joseph H Feinberg
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - O Kenechi Nwawka
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
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Ghali MGZ, Srinivasan VM, Jea A, Slopis JM, McCutcheon IE. Neurofibromas of the Phrenic Nerve: A Case Report and Review of the Literature. World Neurosurg 2016; 88:237-242. [PMID: 26746336 DOI: 10.1016/j.wneu.2015.12.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phrenic neurofibromas are a rare pathologic entity, with 9 cases described in the English literature. They may occur in conjunction with or independently of neurofibromatosis type 1. Phrenic neurofibromas pose distinct therapeutic challenges compared with the more common phrenic schwannoma. We describe here a 12-year-old boy with neurofibroma of the left phrenic nerve presenting as dextroposition of the heart after paralysis of the left hemidiaphragm allowed herniation of abdominal contents into the left hemithorax and displaced the heart. METHOD Surgical resection of the tumor followed by diaphragmatic plication was performed to assess its degree of malignancy, reduce abdominal herniation, and improve lung capacity. RESULTS The operation markedly improved his hemidiaphragmatic elevation. CONCLUSIONS The spectrum of management options ranges from conservative surveillance to open thoracic surgery. Functional preservation of the phrenic nerve is technically challenging, and although phrenic neurofibromas often present with absent function that cannot be recovered, surgical intervention can be fruitful in restoring lung capacity through diaphragmatic reconstruction.
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Affiliation(s)
- Michael G Z Ghali
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Andrew Jea
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - John M Slopis
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ian E McCutcheon
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Intractable hiccups: a rare presentation of phrenic nerve schwannoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:331-3. [PMID: 22981784 DOI: 10.1016/j.anorl.2012.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 01/09/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma as a cause of chronic hiccups due to the involvement of phrenic nerve. CASE PRESENTATION A 72-year-old male presented with 20-year history of hiccups. He underwent multiple esophagogastroduodenoscopy procedures, all of which were negative. A computed tomography (CT-scan) of soft tissue of the neck was remarkable for left retrosternal mass with central calcification, located adjacent to the thyroid gland. He underwent surgery and this mass was found to be originating from the left phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Grossly, the specimen was a pale-tan piece of soft tissue, 4.8 cm in maximum dimension with an attached portion of nerve. Microscopically, it showed a well-circumscribed spindle cell lesion with hypercellular and hypocellular areas and multiple Verocay bodies. There was no atypia or significant mitotic activity. On immunohistochemical staining, the spindle cells were positive for S-100, supporting the diagnosis of schwannoma. CONCLUSION Postoperatively, the patient showed marked improvement in his symptoms and the hiccups were almost completely resolved. Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of chronic hiccups.
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Arishima H, Streichenberger N, Sindou M. Successful excision of a rare cervical neurofibroma arising from the phrenic nerve: a case report. Acta Neurochir (Wien) 2010; 152:327-8. [PMID: 19468678 DOI: 10.1007/s00701-009-0338-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 04/02/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The patient had an enlarging left-side neck mass without neurological symptoms. METHODS Magnetic resonance (MR) imaging revealed a well-demarcated mass close to the left root of C4. RESULTS During the surgery, we confirmed a tumour arising from the cervical phrenic nerve. Although neurogenic tumours of the phrenic nerve are associated with a high risk of causing hemidiaphragm palsy after the total excision, we could carry out a total excision without deficit. CONCLUSION The pathological examination revealed a neurofibroma.
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Affiliation(s)
- Hidetaka Arishima
- Department of Neurosurgery, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
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Canella C, Demondion X, Delebarre A, Moraux A, Cotten H, Cotten A. Anatomical study of phrenic nerve using ultrasound. Eur Radiol 2009; 20:659-65. [DOI: 10.1007/s00330-009-1579-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 07/01/2009] [Accepted: 07/16/2009] [Indexed: 11/29/2022]
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Graham RM, Thomson EF, Woodwards RTM. Benign schwannoma of the left cervical phrenic nerve. Br J Oral Maxillofac Surg 2008; 46:161-2. [PMID: 17416444 DOI: 10.1016/j.bjoms.2007.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2007] [Indexed: 11/23/2022]
Abstract
A patient presented with a benign schwannoma of the cervical phrenic nerve on the left side of the neck. Analysis of the aspirate suggested the diagnosis and it was confirmed on imaging. The patient had the lesion excised with preservation of the phrenic nerve.
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Affiliation(s)
- Richard M Graham
- The Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB, UK.
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