Ancient Schwannoma of the Cervical Sympathetic Chain: A Rare Masquerader of Necrotic Cervical Lymphadenopathy.

Ancient schwannoma is a rare, slow-growing, benign peripheral nerve sheath tumor characterized by long-standing degenerative changes that may clinically, radiologically, and histopathologically mimic malignancy. These tumors commonly present as asymptomatic, gradually enlarging masses in the head and neck region, posing significant diagnostic challenges. We report a rare case of cervical ancient schwannoma in a 53-year-old male who presented with a painless swelling below the left ear of six-month duration. Radiological imaging suggested a necrotic cervical lymph node, and fine-needle aspiration cytology was inconclusive due to hypocellularity. Complete surgical excision was performed, and definitive histopathological examination confirmed the diagnosis of ancient schwannoma. Postoperatively, the patient developed Horner's syndrome, an expected but uncommon complication, which was managed conservatively. This case highlights the complex diagnostic challenges associated with ancient schwannomas, emphasizes the necessity of histopathological confirmation, and illustrates the importance of meticulous preoperative planning to anticipate potential neurological complications.