Head and Neck ImagingNeurogenic tumour, head and neck
neoplasm originating from the neural sheath, including schwannoma, neurofibroma and neurogenic sarcoma.
A schwannoma is a solitary and encapsulated tumour, attached to a nerve; schwannomas often show regressive changes, such as cystic alterations and necrosis. About 25% of the reported schwannomas occur in the head and neck region.
Neurofibromas are not encapsulated and usually occur as multiple lesions; regressive changes are uncommon in these tumours. Neurofibromas may originate from small nerves or major nerve trunks; a plexiform neurofibroma is a fusiform, tortuous tumour, extending proximally and distally along a nerve. Neurofibroma may be a solitary tumour, or part of von Recklinghausens disease.
Neurogenic tumours in the head and neck commonly present as soft tissue swellings; neurological symptoms are only rarely present.
On CT and MR studies, a schwannoma usually appears as a spherical or ovoid soft tissue mass, showing moderate to marked, often inhomogenous, contrast enhancement; cystic components may be apparent, and fatty degeneration is sometimes seen (Fig.1). Neurofibromas can appear less well delineated, and can erode adjacent bone; degenerative changes are only rarely present (Fig.2).
Also, see acoustic schwannoma, carotid space, parapharyngeal space.
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Four-year-old child presenting with painless swelling of right cheek. Axial CT image (a, nonenhanced) shows soft tissue mass (arrow) in masseter muscle, eroding the adjacent mandible. Axial T1-weighted spin-echo image (b) shows strongly enhancing, somewhat lobulated, soft tissue mass. Neurofibroma.
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Neurogenic tumour, head and neck, Fig.1 (a) | | Neurogenic tumour, head and neck, Fig.1 (b) | | Neurogenic tumour, head and neck, Fig.2 (a) |
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Neurogenic tumour, head and neck, Fig.2 (b) | |