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

Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer

• Kim JS
• Yoo CY
• Kim RH
• Cho JH

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 well-circumscribed, 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.

Keyword

Papillary thyroid carcinoma; Cystic metastasis; Schwannoma; Spinal accessory nerve

MeSH Terms

Accessory Nerve
Biopsy
Biopsy, Fine-Needle
Carcinoma, Papillary
Cervical Plexus
Female
Humans
Lymph Nodes*
Lymphatic Diseases
Middle Aged
Neck
Neoplasm Metastasis
Neurilemmoma*
Thyroid Gland
Thyroid Neoplasms*
Tomography, X-Ray Computed
Ultrasonography

Figure

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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.

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  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).

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  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.

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  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).

Reference

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