The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.
Aged ; Antitubercular Agents ; therapeutic use ; Female ; Humans ; Lymph Nodes ; microbiology ; pathology ; Tuberculosis, Lymph Node ; diagnosis ; drug therapy

OBJECTIVES: To present a case of cervical vagal schwannoma and describe our experience with the clinical presentation, surgical and outcome of an elderly patient with this pathology.

METHODS:
Design: Case report
Setting: Tertiary Public Hospital
Patient: One

RESULTS: A 65-year-old lady presented with a recently enlarging, pulsatile right sided neck mass that had been asymptomatic for 15 years. Contrast CT revealed a circumscribed non-enhancing heterogenous 4 x 4 x 7 cm mass splaying the right internal jugular vein and common carotid artery. A neurogenic tumour was considered, and the mass was exercised from the vagus nerve with preservation of adjacent structures. Final histopathologic reading was schwannoma. However, the patient succumbed to complications following a second surgery for expanding hematoma.

CONCLUSION:  Schwannomas are benign, slow growing tumours that arise from Schwann cells of the nerve sheath. Cervical schwannomas originating from the vagus are rare but should be considered in patients presenting with solitary neck masses. Surgical extirpation is still the treatment of choice for nerve sheath tumours and recurrence is uncommon. Efforts should be made to preserve unaffected structures and patients should be counseled preoperatively on the possible high risk of morbidity especially in the elderly group where close follow up and aggressive rehabilitation should be instituted following surgery.

Human ; Female ; Aortic Bodies ; Neurilemmoma-therapy ; General Surgery ; Neoplasms ; Tomography Scanners, X-ray Computed ; Schwann Cells ; Vagus Nerve