Department of Neurologic Surgery, Mayo Clinic, Gonda 8S-214, 200 First Street SW, Rochester, MN 55905, USA.
Acta Neurochir (Wien). 2010 Sep;152(9):1567-76. doi: 10.1007/s00701-010-0682-x. Epub 2010 May 15.
Prostate adenocarcinoma, which may recur despite aggressive treatment, has the potential to spread to the lumbosacral plexus. This intraneural involvement is not widely known and is thought to be from direct perineural spread. We hypothesized that high-resolution imaging could provide supportive evidence for this mechanism.
The clinical data and imaging studies (magnetic resonance imaging, MRI, and positron emission tomography/computed tomography, PET/CT) of patients evaluated at our institution between 2004 and 2009 for lumbosacral plexopathy due to intraneural prostate carcinoma were retrospectively reviewed.
Four patients presenting with painful lumbosacral plexopathy were found to have intraneural lumbosacral prostate adenocarcinoma. Two patients had involvement of the lumbosacral plexus ipsilateral to the lobe of the prostate most involved with adenocarcinoma at prostatectomy. High-resolution MRI and PET/CT studies revealed similar findings: abnormal soft tissue signal was followed from the prostate (n = 1) or prostatic bed (n = 3) area along the expected course of the pelvic plexus to the level of the sciatic notch, where it involved the sacral spinal nerves and sciatic nerve. Imaging findings were consistent with neoplastic infiltration, which was confirmed at biopsy in three patients.
The potential for prostate adenocarcinoma to spread to the lumbosacral plexus has, to our knowledge, not been readily appreciated. Because the imaging findings are often subtle, we believe that intraneural lumbosacral plexus involvement may not be uncommon. This study, with the use of high-resolution MRI and PET/CT studies, supports the direct perineural spread of prostate adenocarcinoma via the pelvic plexus to the lumbosacral plexus. This mechanism could also explain cases of leptomeningeal and/or dural-based prostate metastases.
前列腺腺癌尽管经过积极治疗仍可能复发，且有向腰骶丛扩散的潜力。这种神经内累及并不广为人知，据认为是直接沿神经周围扩散所致。我们假设高分辨率成像可以为此机制提供支持性证据。
回顾性分析了 2004 年至 2009 年间在我院因神经内前列腺癌所致腰骶丛病变而接受评估的患者的临床数据和影像学研究（磁共振成像、MRI 和正电子发射断层扫描/计算机断层扫描、PET/CT）。
发现 4 例出现腰骶丛神经病的疼痛患者存在神经内腰骶前列腺腺癌。2 例患者的腰骶丛受累与前列腺切除术时前列腺腺癌最受累的叶同侧。高分辨率 MRI 和 PET/CT 研究显示出相似的发现：异常软组织信号从前列腺（n = 1）或前列腺床（n = 3）区域沿着骨盆丛的预期路径一直延伸到坐骨切迹，在那里它累及骶脊神经和坐骨神经。影像学发现与肿瘤浸润一致，3 例患者的活检结果证实了这一点。
据我们所知，前列腺腺癌向腰骶丛扩散的可能性尚未得到充分认识。由于影像学表现通常较为微妙，我们认为神经内腰骶丛受累可能并不少见。这项研究结合了高分辨率 MRI 和 PET/CT 研究，支持了前列腺腺癌通过骨盆丛直接向腰骶丛扩散的神经周围扩散机制。该机制也可以解释脑膜和/或硬脑膜内前列腺转移的病例。
