Abstract A 66-year-old man presented with a year-long history of progressive dysphagia, globus sensation, muffled dysphonia, and dyspnea on exertion. He reported choking with both liquids and solids, regurgitation, and weight loss. His symptoms also included neck pain and stiffness. Past medical history was notable for prostate cancer and resection of a benign posterior neck mass 30 years earlier. He was admitted with aspiration pneumonia, prompting imaging that revealed a retropharyngeal mass. Schwannomas, or neurilemmomas, are benign encapsulated tumors originating from Schwann cells of the peripheral nerve sheath, constituting about 1% of head and neck tumors. Although these tumors frequently involve cranial nerves VIII and X or the cervical sympathetic chain, involvement of the pharyngeal plexus is rare. They characteristically present as slow-growing, painless, and mobile neck masses that may cause compressive symptoms such as dysphagia or dysphonia. Radiographically, schwannomas typically appear as well-circumscribed, homogeneously enhancing lesions on contrast-enhanced CT and as hypointense masses on T1-weighted and hyperintense on T2-weighted MRI. Fine-needle aspiration biopsy often provides insufficient diagnostic material, making histopathological confirmation after surgical excision essential. Histology typically demonstrates the biphasic Antoni A and Antoni B patterns. Antoni A regions feature cellular spindle cells arranged in fascicles with Verocay bodies, whereas Antoni B regions are less cellular and myxoid. Immunohistochemical staining for S-100 protein confirms Schwann cell origin. The standard of care for symptomatic or enlarging schwannomas is complete surgical excision. Because the tumors are encapsulated, resection is often feasible without injuring the parent nerve. However, when arising from critical neural structures, the risk of postoperative neurological deficits must be considered. In this case, intraoperative findings identified a large encapsulated tumor originating from the pharyngeal plexus. A tracheostomy and nasogastric tube were placed to protect airway and swallowing functions postoperatively. The patient recovered uneventfully, regaining normal swallowing and voice, and both tubes were removed within one week. The final diagnosis confirmed a benign pharyngeal plexus schwannoma. Prognosis following complete resection is excellent, with a low recurrence rate. This case underscores the diagnostic challenge posed by retropharyngeal schwannomas and the importance of including them in the differential diagnosis for progressive dysphagia and neck masses. Early surgical management provides both symptom resolution and curative outcomes. This abstract is funded by: None
Moin et al. (Fri,) studied this question.