Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea.
World Neurosurg. 2018 Jul;115:85-88. doi: 10.1016/j.wneu.2018.04.030. Epub 2018 Apr 13.
Perineural spread is not an uncommon feature in carcinoma of the head and neck. On the contrary, perineural spread in pelvic malignancies has been rarely reported. This is the first report on perineural spread of the obturator nerve and the lumbosacral plexus from primary vaginal cancer.
A 50-year-old woman diagnosed with infectious spondylitis at an outside hospital was referred to our institution. She presented with persistent lower back pain and right anterior thigh pain. Magnetic resonance imaging and subsequent F-fluorodeoxyglucose-positron emission tomography/computed tomography revealed primary vaginal cancer with metastatic lymphadenopathy and perineural spread of the lumbosacral plexus, including L3, L4 nerve roots and branches, and obturator nerve along with soft tissue masses in the right psoas and proximal adductor muscles.
Clinical diagnosis of perineural spread in pelvic malignancies is difficult to establish, as it has nonspecific symptoms as an initial manifestation. Clinicians should recognize the possibility of perineural spread of malignancies if radiologic findings, such as thickening of lumbosacral nerves and perineural mass, are observed on magnetic resonance imaging. Further evaluation is necessary to detect possible pelvic malignancy and differentiate from other diseases.
神经周围扩散在头颈部癌中并不少见。相反，盆腔恶性肿瘤的神经周围扩散很少见报道。这是首例原发性阴道癌累及闭孔神经和腰骶丛的神经周围扩散报告。
一名 50 岁女性因在院外诊断为感染性脊椎炎而转至我院。她表现为持续性腰痛和右大腿前疼痛。磁共振成像和随后的 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描显示原发性阴道癌伴淋巴结转移和腰骶丛神经周围扩散，包括 L3、L4 神经根及其分支以及闭孔神经，同时伴有右侧腰大肌和近端内收肌的软组织肿块。
盆腔恶性肿瘤的神经周围扩散的临床诊断难以确立，因为其最初表现为无特异性症状。如果磁共振成像上观察到腰骶神经增粗和神经周围肿块等放射学表现，临床医生应认识到恶性肿瘤发生神经周围扩散的可能性。需要进一步评估以发现可能的盆腔恶性肿瘤并与其他疾病相鉴别。
