A 50-year-old woman with a long history of hypertension as a co-morbid, presented with a swelling on the right side of neck for seven years which had gradually increased in size. She also complained of dyspnoea on lying down flat without a pillow. General physical examination was unremarkable. Significant findings included a BP of 160/100 mmHg and Homer`s syndrome on the right side which comprised of partial ptosis and miosis of the right eye, and hemianhydrosis. On local examination, the swelling was 8x10 cms. in size, extending from posterior triangle and encroaching into the anterior triangle. Ultrasonograph showed a complex, well encapsulated, predominantly solid mass, suggestive of a benign growth of the right lobe of thyroid. Further workup by thyroid scan and fine needle aspiration cytology (FNAC) was advised. Thyroid Scintograph showed normal thyroid status with hormonal assay in normal range. FNAC revealed spindle like cells arranged in cellular and loose areas which were suggestive of a Nerve Sheath Tumor (Schwannoma). Magnetic resonance imaging (MRI) showed a well defined, heterogeneous mass in the neck, appearing completely encapsulated. The mass returned heterogenous high T2 signals from its substance. It also displaced the vascular and other soft tissue structures without any evidence of invasion. This was most likely a nerve sheath tumor arising from cervical sympathetic chain.
PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com