title: Diagnosis and management of cervical sympathetic chain schwannoma: a review of 9 cases.
abstract: CONCLUSIONS
  Cervical sympathetic chain schwannoma (CSCS) sometimes mimics carotid body tumor (CBT). Differential diagnosis between these tumors is sometimes difficult using MRI alone. MRA, color Doppler ultrasonography, and fine needle aspiration (FNA) after imaging may be helpful to rule out CBT. Surgical resection of CSCS is relatively effortless, and Horner's syndrome is an expected but acceptable postoperative complication. Intratumoral hemorrhage and vasodilation may be the main reasons for significant enhancement on MRI.
  
  
  OBJECTIVE
  CSCSs are rare and known to mimic carotid body tumors. We report 9 cases of CSCS with an emphasis on imaging, surgical management, and pathological findings. Moreover, we describe the differential diagnosis of CSCS and CBT, and speculate the reasons behind significant enhancement on MRI.
  
  
  METHODS
  Nine cases of CSCS treated at a tertiary referral center between 1996 and 2008 were reviewed.
  
  
  RESULTS
  MRI revealed 3 of 9 cases (33%) splayed the carotid bifurcation and displayed marked contrast enhancement with gadolinium. All patients underwent surgical excision of the mass with minimal blood loss. Postoperative Horner's syndrome was encountered in all patients, which required no treatment. Marked gadolinium enhancement tended to be associated with histological findings such as intratumoral hemorrhage and vasodilation.
authors.affiliation: Department of Otolaryngology, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, Japan. t-tomita@sc.itc.keio.ac.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tomita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ozawa
authors.forename: Koji
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ogawa
authors.forename: Kaori
authors.initials: K
authors.lastname: Kameyama
authors.forename: Masato
authors.initials: M
authors.lastname: Fujii
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D003287:Contrast Media; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D019786:Gadolinium DTPA; D005728:Ganglia, Sympathetic / Q000473:pathology* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000601:surgery; D006732:Horner Syndrome / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis* / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis* / Q000601:surgery*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA