Cervical sympathetic chain schwannomas masquerading as carotid body tumors

Cervical sympathetic chain (CSC) schwannoma is a rare neurogenic tumor that can mimic a carotid body tumor (CBT). Two male patients aged 33 and 49 years old were referred for a cervical mass thought to be a CBT. Both patients were found to have an asymptomatic, pulsatile, nontender mass located at the level of the angle of the mandible. Both patients were neurologically asymptomatic and cranial nerves were normal. Both patients underwent neck exploration and resection of the mass involving the CSC. Postoperatively, a Horner's syndrome was present. Histopathology confirmed both tumors to be schwannomas of the CSC. At follow-up, both patients are asymptomatic with no recurrence. The main imaging criterion to differentiate a CBT from a CSC schwannoma is the lack of hypervascularity of the latter. Malignant transformation is extremely rare. Tumor excision gives excellent results with no local recurrence. Horner's syndrome is an expected postoperative complication.