Vagal nerve schwannoma presenting as pleomorphic adenoma: diagnostic cost of cytologic dependence

Cervical vagal schwannomas are rare benign nerve sheath tumours that present diagnostic and management challenges due to slow growth and proximity to vital neck structures. Fine-needle aspiration cytology (FNAC) may be unreliable and lead to misdiagnosis, whereas MRI is the preferred modality for accurate evaluation and surgical planning. A woman in her early 50s presented with a painless, slow-growing mass at the right mandibular angle, initially diagnosed as pleomorphic adenoma on FNAC and managed conservatively. Eleven months later, she developed exertional dizziness and sought reassessment. MRI revealed a large right carotid space lesion suggestive of a vagal schwannoma. Surgical excision confirmed the diagnosis. This case highlights the diagnostic limitations of cytology, the importance of MRI and the risk of significant postoperative complications necessitating thorough counselling and multidisciplinary care.