Presentation
Palpable painless right neck mass for 1 year.
Patient Data
There is a large 5 cm enhancing mass in the right carotid space that displaces the internal and external carotid arteries anteromedially and the internal jugular vein anterolaterally.
FINE NEEDLE ASPIRATE REPORT
Diagnosis:
A/AFS. Soft tissue Vagus nerve mass, fine needle aspiration with rapid onset evaluation X2: Spindle cell lesion, consistent with Schwannoma.
COMMENT: Immunostains show that the spindle cells are positive for s100, negative for synaptophysin.
Case Discussion
The differential for carotid space lesions is glomus vagale paraganglioma, carotid body tumor, vagus nerve schwannoma, and sympathetic plexus schwannoma. Displacement of the carotid arteries and jugular vein as well as enhancement characteristics are helpful for differentiating between these lesions.
Vagus nerve schwannoma will displace the ICA and ECA anteromedially and the jugular vein laterally. A sympathetic plexus schwannoma can be difficult to differentiate as it arises in the posterior aspect carotid sheath and will also displace the jugular vein anteriorly. Glomus vagale paraganglioma will be hypervascular and would be expected to show greater enhancement. They will displace the ICA and ECA anteriorly and the jugular vein posteriorly. Carotid body tumors will splay the ICA and ECA and displace the ICA posteriorly.
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