Long-standing neck mass: A rare case of vagal paraganglioma

Vagal paragangliomas (VPG) are rare, slow-growing tumors of the head and neck, often asymptomatic but can present as progressively enlarging neck masses. These tumors are predominantly benign but have the potential for malignant behavior in a small percentage of cases. Diagnosis typically involves clinical examination, imaging studies, and fine needle aspiration cytology (FNAC). Surgical excision remains the treatment of choice for large, resectable masses.

We report a case of a 55-year-old female with a long-standing, gradually enlarging, painless right-sided neck mass. The mass had been present for 10 years, with no associated symptoms of catecholamine hypersecretion. Examination revealed a large, non-lobulated swelling. FNAC and imaging, including ultrasound and contrast-enhanced CT, confirmed the diagnosis of vagal paraganglioma. The patient underwent successful surgical excision with minimal postoperative complications and was discharged on the third postoperative day.

Vagal paragangliomas typically present as neck masses and may lead to cranial nerve dysfunction. Imaging modalities such as CT, MRI, and angiography are essential for diagnosis and surgical planning. Surgical excision remains the primary treatment, though nerve-sparing procedures are uncommon and carry a risk of postoperative cranial nerve deficits. In our case, recovery was favorable, but such outcomes should be interpreted with caution given the potential for complications reported in the literature.

This case highlights the importance of considering vagal paragangliomas in the differential diagnosis of neck masses. Diagnosis relies on careful clinical evaluation and imaging, while surgical excision remains the mainstay of treatment for resectable lesions. Although our patient's recovery was favorable, potential cranial nerve and vascular complications should be anticipated. Further research and genetic studies are needed to better define long-term outcomes and management strategies.