Traumatic Neuroma after Neck Dissection: CT Characteristics in Four Cases
Lynn F. Huanga,
Jane L. Weissman
,a and
Chun-yung Fana
a From the Department of Radiology, University of Pittsburgh Medical Center (L.F.H.); the Department of Radiology and Otolaryngology, Oregon Health Sciences University, Portland (J.L.W.); and the Department of Pathology, University of Arkansas Medical Center, Little Rock (C.F.).
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FIG 1. 59-year-old man with squamous cell carcinoma of the larynx after left-sided modified radical neck dissection (type 1) with sparing of the spinal accessory nerve.
A, Axial contrast-enhanced CT scan of the neck shows a nodule (large arrow) with a radiolucent center, peripherally dense rim, and an intact layer of overlying fat (small arrow). The nodule lies posterolateral and close to the left CCA (arrowhead). The left sternocleidomastoid muscle and left internal jugular vein are absent.
B, Axial contrast-enhanced CT scan of the neck obtained 1 year after A shows the nodule (arrow) to be minimally increased in size, which is highly atypical for tumor.
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FIG 2. 45-year-old man after left-sided modified radical neck dissection (type 1) with sparing of the spinal accessory nerve 1 year after a left partial glossectomy and selective neck dissection (types 1 and 2) for squamous cell carcinoma of the tongue.
A, Axial contrast-enhanced CT scan shows a nodule (large straight arrow) with a radiolucent center, peripherally dense rim, and an intact layer of overlying subcutaneous fat (small arrow). This nodule is posterolateral and close to the left CCA (arrowhead). Left-sided hypoglossal denervation (curved arrow) is also present.
B, Axial contrast-enhanced CT scan 1 year after A shows this nodule (large arrow) and its intact layer of overlying fat (small arrow) remain unchanged.
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FIG 3. 54-year-old woman 4 years after left-sided modified radical neck dissection with sparing of the spinal accessory nerve for parotid adenocarcinoma now with a trigger point.
A, Axial contrast-enhanced CT scan shows a nodule (long arrow) with faint central radiolucency, a peripherally dense rim, and an intact layer of overlying fat (short arrow). This nodule lies posterolateral and close to the left ICA.
B, Axial contrast-enhanced CT obtained 2 years after A shows this nodule (arrow) to be stable.
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FIG 4. 64-year-old man with a right-sided neck mass 7 months after right-sided modified radical neck dissection and knife excision of zones I through V for squamous cell carcinoma of the larynx.
A, Axial contrast-enhanced CT scan reveals a nodule (arrow) posterolateral to but separate from the right ICA (arrowhead). The nodule lacks a radiolucent center and peripherally dense rim.
B, Microscopic section of the nodule reveals tangled and interwoven neurofibrils (arrowheads) mixed with connective tissue, typical of a traumatic neuroma (hematoxylin-eosin, x400).
C, Another microscopic section of the nodule also reveals other areas containing abnormally mitotic nuclei (arrows), typical of carcinoma mixed with areas typical of traumatic neuroma (hematoxylin-eosin, x400).
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FIG 5. 52-year-old man with a possible neck mass after prior bilateral radical neck dissections for squamous cell carcinoma of the tongue.
A, Axial contrast-enhanced CT scan shows a heterogeneous nodule (arrow), posterolateral to the left ICA (arrowhead), which lacks a radiolucent center and peripherally dense rim.
B, Axial contrast-enhanced CT scan 3 months after A shows the nodule (curved arrow) to be enlarged and invading the overlying subcutaneous fat (straight arrow). This nodule was pathologically proved to be recurrent squamous cell carcinoma.
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