Clinical characteristics and treatment strategies for thyroid carcinoma combined with cervical vagus nerve schwannoma
10.3760/cma.j.cn115807-20250528-00146
- VernacularTitle:甲状腺癌合并颈段迷走神经鞘瘤的诊疗策略
- Author:
Weihua JIAN
1
;
Zhen CHEN
1
;
Jianhua FENG
1
;
Wensong CAI
1
;
Bo XU
1
Author Information
1. 广州市第一人民医院（华南理工大学附属第二医院）甲状腺乳腺外科，广州 510180
- Publication Type:Journal Article
- Keywords:
Thyroid cancer;
Vagal schwannoma;
Treatment strategies
- From:
Chinese Journal of Endocrine Surgery
2025;19(4):547-551
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the diagnostic and surgical strategies in managing patients with coexisting thyroid carcinoma and cervical vagal schwannoma.Methods:We retrospectively analyzed three cases treated at Guangzhou First People’s Hospital between Jun. 2019 and Dec. 2024.Results:All patients presented with neck masses or thyroid nodules. Ultrasonography identified suspicious malignant thyroid nodules and lateral neck lesions—interpreted as metastatic lymphadenopathy in two cases and as a possible nerve sheath tumor in one. Fine-needle aspiration cytology (FNAC) of thyroid nodules yielded Bethesda VI results in all cases. FNAC of the lateral neck lesions revealed no evidence of malignancy in all cases; in one case, a core needle biopsy confirmed a vagal schwannoma. Two patients underwent MRI, which supported the diagnosis of vagal schwannoma. Surgical management included single-stage resection in two patients and staged surgery in one. Postoperative histopathology confirmed papillary thyroid carcinoma and schwannoma in all cases. Transient postoperative hoarseness occurred in two patients, with recovery within 3-6 months.Conclusions:When thyroid carcinoma is complicated by cervical vagal schwannoma, the schwannoma may be misdiagnosed as metastatic cervical lymph nodes, potentially leading to iatrogenic vagus nerve injury during neck dissection. Although cervical vagal schwannoma can be diagnosed preoperatively, simultaneous surgical treatment of both conditions may increase the risk of vocal cord paralysis, and in severe cases, result in airway compromise. Therefore, comprehensive preoperative evaluation is important. It is recommended to classify cases based on the anatomical locations of the thyroid carcinoma and vagal schwannoma to guide surgical planning, and to use intraoperative nerve monitoring to enhance surgical safety and avoid serious complications.
