J Korean Thyroid Assoc.  2014 May;7(1):92-95.

A Case of Schwannoma of the Recurrent Laryngeal Nerve Associated with Vocal Cord Palsy after Fine-Needle Aspiration

• Lee JW
• Kim Y
• Kim HK
• Kang HC

Abstract

Approximately 25-45% of all schwannomas occur in the head and neck, and lesions originating from the recurrent laryngeal nerve are very rare. When a tumor is located in the neck, it is difficult to differentiate schwannoma from other lesions including thyroid, parathyroid, or esophageal masses; or lymphoma. We report here a case of schwannoma of the recurrent laryngeal nerve, confused with a thyroid mass, in a 67-year-old woman. Our patient complained of hoarseness after fine-needle aspiration of the mass. It was diagnosed as vocal cord palsy and she underwent surgery for mass removal. Pathological examination showed that the mass was an ancient schwannoma. The case suggests that clinicians should note that schwannoma of the recurrent laryngeal nerve may present as a thyroid mass, and hoarseness is one possible complication developing after fine-needle aspiration or surgery.

Keyword

Schwannoma; Recurrent laryngeal nerve; Hoarseness; Fine-needle aspiration

MeSH Terms

Aged
Biopsy, Fine-Needle*
Female
Head
Hoarseness
Humans
Lymphoma
Neck
Neurilemmoma*
Recurrent Laryngeal Nerve*
Thyroid Gland
Vocal Cord Paralysis*

Figure

• 

  Fig. 1. Imaging studies. (A) A thyroid ultrasound scan revealed a well-defined hypoechoic mass 3.1 × 2.6 × 7.5 cm in dimensions adjacent to the left thyroid gland. (B) Neck CT showed a well–defined heterogeneously enhanced mass (black arrow) 3.6 × 2.9 × 8.3 cm in dimensions extending into the mediastinum.

• 

  Fig. 2. The resected specimen features a yellowish tumor with the consistency of firm rubber (white arrow) and the left thyroid gland (black arrow), of dimensions 3.0 × 2.5 × 9.0 cm and 4.0 × 3.0 × 1.5 cm, respectively. The mass was adherent to the left recurrent laryngeal nerve.

• 

  Fig. 3. Microscopic findings. (A) Histologically, the tumor contained spindle-shaped cells with elongated nuclei (H&E stain, × 200). An Antoni A area exhibiting hypercellularity was evident. (B) The tumor cells were immunoreactive for the S–100 protein (H&E stain, X 200).

Reference

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