Alelaumi Ahmad, Khamees Almu'Atasim, Alfawareh Mohammad, Khalil Osama, Zahran Anas
Department of Orthopedics and Spine Surgery, King Hussein Cancer Center, Amman, Jordan.
Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
Int J Surg Case Rep. 2025 Jan;126:110610. doi: 10.1016/j.ijscr.2024.110610. Epub 2024 Nov 14.
Diagnosing brachial plexopathy in cancer patients who have undergone treatment and are being monitored presents a significant difficulty due to the potential involvement of multiple factors, including tumor recurrence causing compression or infiltration, recurrent metastasis, or the effects of radiation therapy. Malignant peripheral nerve sheath tumors (MPNSTs) have the potential to impact the brachial plexus, resulting in brachial plexopathy. Misdiagnosis can lead to catastrophic outcomes.
A 29-year-old female patient, who had a previous history of nasopharyngeal carcinoma, exhibited symptoms consistent with brachial plexopathy. The primary diagnoses for the cause were tumor metastatic recurrence and radiation-induced brachial plexopathy. Following an evaluation, recurrence appeared to be the most probable diagnosis. The mass had infiltrated along the brachial plexus, resulting in an intradural mass that led to cord compression. The final pathology report confirmed that the original pathology was malignant peripheral nerve sheath tumor (MPNST).
Understanding the underlying causes of brachial plexopathy is crucial for accurate diagnosis, particularly in cancer patients and those with a history of radiotherapy, as these individuals may present with complex or atypical symptoms that can complicate the diagnostic process. In such cases, distinguishing between tumor-related brachial plexopathy, radiation-induced nerve damage, and other potential etiologies is essential for guiding appropriate treatment strategies and improving patient outcomes.
Comprehensive and prompt evaluation is crucial in cases of brachial plexopathy with a history of cancer, aiming to prevent misdiagnosis and minimize complications.
在已接受治疗并处于监测阶段的癌症患者中诊断臂丛神经病变存在重大困难，因为可能涉及多种因素，包括肿瘤复发导致压迫或浸润、复发转移或放射治疗的影响。恶性外周神经鞘瘤（MPNST）有可能累及臂丛神经，导致臂丛神经病变。误诊可能导致灾难性后果。
一名29岁女性患者，既往有鼻咽癌病史，出现了与臂丛神经病变相符的症状。病因的初步诊断为肿瘤转移性复发和放射性臂丛神经病变。经过评估，复发似乎是最可能的诊断。肿块沿臂丛神经浸润，导致硬膜内肿块并引起脊髓压迫。最终病理报告证实原发病理为恶性外周神经鞘瘤（MPNST）。
了解臂丛神经病变的潜在病因对于准确诊断至关重要，尤其是在癌症患者和有放疗史的患者中，因为这些患者可能出现复杂或非典型症状，使诊断过程复杂化。在这种情况下，区分肿瘤相关性臂丛神经病变、放射性神经损伤和其他潜在病因对于指导适当的治疗策略和改善患者预后至关重要。
对于有癌症病史的臂丛神经病变病例，全面而迅速的评估至关重要，旨在防止误诊并将并发症降至最低。
