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題名 | Huge Anterior Neck Schwannoma Mimicking a Malignant Thyroid Tumor--Case Report=表現類似惡性甲狀腺腫瘤的前頸部巨型許旺細胞瘤--病例報告 |
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作者 | 陳彥均; 洪士涵; 林雅芳; 許信德; | 書刊名 | 臺灣耳鼻喉頭頸外科雜誌 |
卷期 | 52:4 2017.10-12[民106.10-12] |
頁次 | 頁191-196 |
分類號 | 415.931 |
關鍵詞 | 許旺細胞瘤; 甲狀腺腫塊; 甲狀腺癌; Schwannoma; Thyroid tumor or malignancy; |
語文 | 英文(English) |
中文摘要 | 許旺細胞瘤源自於周邊神經的神經鞘細胞,為一良性腫瘤,可出現在全身多處地方。前頸部許旺細胞瘤臨床上並不常見,腫瘤本身緩慢生長加上不明顯的症狀表現,常常無法於術前得到確診。本院收治1名自內分泌科轉診之61歲男性病患,主訴前頸部腫塊近3年內逐漸變大。病患無聲音沙啞、吞嚥困難、呼吸不順等症狀,觸診發現前下頸部甲狀腺區有一接近13 cm可移動的實心腫塊,無壓痛,表皮無紅腫變化,疑似甲狀腺腫大或是惡性腫瘤。術中發現腫塊範圍延伸到胸骨高度,合併上食道及左側喉返神經嚴重沾黏。病理診斷為許旺細胞瘤,並有部份食道侵犯。術後追蹤發現左側聲帶麻痺。表現類似惡性甲狀腺腫瘤的前頸部許旺細胞瘤相對少見,故提出報告,在視診前頸部腫塊時,若臨床症狀不甚明顯,也需將許旺細胞瘤放入鑑別診斷,搭配影像學檢查以找出可能的神經來源,減少術後神經功能的損傷。 |
英文摘要 | Schwannomas are non-malignant tumors which arise from neuronal sheath cells of peripheral nerves. Schwannomas can occur at many areas, but anterior neck origins are not common. Their indolent growth and non-specific symptoms of compression often dissuade correct preoperative diagnosis. We present a 61-year-old man with a slow-growing left lower neck mass in past five years. No hoarseness, dysphagia, or respiratory disturbance was identified. Physical examination showed a solid, nontender mass measured around 13 cm over left lower neck region. Huge goiter or thyroid malignancy was suspected. Intraoperatively, the tumor was found to extend to near the sternum level. Tight adhesions of the tumor with upper esophagus and the left recurrent laryngeal nerve were identified. Cervical schwannoma was diagnosed by pathology, with evidence of esophageal involvement. Left vocal cord paralysis was revealed upon follow up. When it comes to anterior neck mass with no or non-specific symptoms, care should be taken to include schwannoma into the differential diagnosis, in order to raise the awareness of arranging adequate image modalities to survey the possible nerve of origin, and thus lessen postoperative neurological deficit. |
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