PMC5667449_01
Anterior and lateral view of neck mass
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Fig1
The swelling was extending superiorly at level of right angle of mandible, inferiorly 2 cm below the suprasternal notch, laterally 1 cm behind the posterior border of right sternocleidomastoid muscle and medially in the midline of neck (Fig. 1). 
CT of neck (coronal view)
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Fig2
Plain and contrast enhanced CT was suggestive of high flow vascular malformation (Figs. 2, 3, 4).
CT of neck (axial view)
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Fig3
Plain and contrast enhanced CT was suggestive of high flow vascular malformation (Figs. 2, 3, 4).
CT of neck (sagittal view)
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Fig4
Plain and contrast enhanced CT was suggestive of high flow vascular malformation (Figs. 2, 3, 4).
MRI of neck
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Fig5
MRI was suggestive of high flow vascular malformation or neoplastic mass having high vascularity in it (Fig. 5).    
CT angiography of neck
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Fig6
CT angiography (3D)
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Fig7
Exposure of mass with adherence to sternocleidomastoid and trapezius muscles
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Fig8
Intraoperatively, the mass was adhered to sternocleidomastoid muscle extending upto hyoid bone level superiorly and extended inferiorly upto the supraclavicular fossa, feeding vessels from right subclavian, external carotid, common carotid artery, thyrocervical trunk were ligated and also the draining vessels towards internal jugular vein were also ligated and the entire mass was removed in toto (Figs. 8, 9, 10).
Accessory nerve
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Fig9
Intraoperatively, the mass was adhered to sternocleidomastoid muscle extending upto hyoid bone level superiorly and extended inferiorly upto the supraclavicular fossa, feeding vessels from right subclavian, external carotid, common carotid artery, thyrocervical trunk were ligated and also the draining vessels towards internal jugular vein were also ligated and the entire mass was removed in toto (Figs. 8, 9, 10).
Excised mass 8 x 7 cm
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Fig10
Intraoperatively, the mass was adhered to sternocleidomastoid muscle extending upto hyoid bone level superiorly and extended inferiorly upto the supraclavicular fossa, feeding vessels from right subclavian, external carotid, common carotid artery, thyrocervical trunk were ligated and also the draining vessels towards internal jugular vein were also ligated and the entire mass was removed in toto (Figs. 8, 9, 10).
Skin closure with Prolene cutting body suture 4.0 and number 10 Romovac drain in situ
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Fig11
Haemostasis was secured and closed with Romovac drain number 10 (Fig. 11).    
7 months follow up
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Fig12
Postoperatively she was free of complications and also at her subsequent follow ups (Fig. 12).
(a) low power view (x100) prominent thin walled blood vessels with proliferation of tumor cells around it along with variable proportion of smooth muscle and, (b) high power view (x400) individual tumor cells are small, uniform, round with central nucleus, discernible nucleoli and eosinophilic cytoplasm
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Fig13
However, no overt atypia/atypical mitosis evident (Fig. 13).