A rare cervical mass associated with preoperative Horner’s syndrome

Mircea Ciurea, Rares Roman, Madalina Anca Moldovan, Daniel Ostas, Dragos Termure, Horatiu Rotaru

Department of Oral and Cranio-Maxillofacial Surgery, "Iuliu Hatieanu" University of Medicine and Pharmacy; Motilor Street 33, 400001, Cluj-Napoca, Romania

Introduction: Schwannomas arising from the cervical sympathetic trunk are the most common benign nerve sheath tumors in the parapharyngeal space. They present as an asymptomatic slow-growing neck mass, without neurological symptoms. The purpose of this paper is to emphasize the rarity of the sympathetic chain cervical schwannoma with preoperative Horner’s syndrome and aims to describe the presentation, imaging evaluations, surgical technique, and outcome.

Case presentation: A 51-year-old male was admitted in our department for a left neck mass associated with blepharoptosis, miosis and anhidrosis. The preoperative diagnosis of a sympathetic chain tumor relied on clinical and imaging studies. Horner’s syndrome, which rarely appears preoperatively, was detected on preoperative clinical evaluation, contributing to a faster and more precise diagnosis. The internal carotid artery and internal jugular vein were altogether displaced antero-laterally on contrast-enhanced CT and MRI. The patient underwent surgical excision as the treatment of choice. Histopathological examination confirmed the diagnosis of sympathetic chain schwannoma. Postoperative the patient had first bite syndrome, pain in the left shoulder, voice hoarseness and coughing, foreign body sensation, tongue biting and deviation that gradually disappeared during the following 18 months.

Conclusion: In the case of a cervical mass, schwannoma must be considered as a diagnosis, particularly when there neurological signs are present. Preoperative diagnostic evaluation and rigorous planning of surgical intervention in cervical sympathetic chain schwannomas are essential. Our case supports the theory that a cervical schwannoma pushing forward both the internal jugular vein and the carotid artery suggests an origin from the sympathetic chain.