A cervical schwannoma masquerading as a thyroid nodule: a surgical diagnostic pitfall - a case report

Midline neck swellings that move with deglutition are commonly attributed to thyroid pathology. However, non-thyroidal cervical lesions may occasionally mimic thyroid nodules, leading to diagnostic uncertainty. Cervical schwannomas presenting in the thyroid bed region are uncommon and can closely resemble benign thyroid lesions on clinical examination and imaging.

The authors report a case of a 55-year-old female who presented with a progressively enlarging anterior neck swelling associated with dysphagia. Clinical examination and ultrasonography suggested a benign thyroid nodule (TIRADS-2), and fine-needle aspiration cytology was inconclusive, favoring a colloid lesion. Surgical exploration, planned for thyroid pathology, unexpectedly revealed an extrathyroidal cervical mass, separate from the thyroid gland. Complete excision was performed, and histopathological evaluation confirmed the diagnosis of schwannoma.

Cervical schwannomas located adjacent to the thyroid gland pose significant diagnostic challenges due to their ability to mimic thyroid lesions. Imaging and cytology may be misleading, particularly when lesions demonstrate movement with deglutition. This case emphasizes the limitations of routine fine needle aspiration cytology and the importance of maintaining a broad differential diagnosis when evaluating thyroid-like neck swellings.

This case underscores the need for heightened clinical suspicion of non-thyroidal etiologies in patients presenting with presumed thyroid nodules. Accurate diagnosis relies on a combination of careful surgical assessment and histopathological confirmation, helping to prevent unnecessary thyroid surgery and optimize patient outcomes.