Im Yu Jin, Yoon Young Cheol, Sung Duk Hyun
Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Acta Neurochir (Wien). 2024 Dec 2;166(1):490. doi: 10.1007/s00701-024-06381-8.
Perineural tumor spread (PNTS) to the brachial plexus (BP) is a rare and challenging condition. This study aimed to elucidate the clinical presentations, diagnostic challenges, and outcomes of patients with PNTS to the BP.
We retrospectively reviewed patients diagnosed with PNTS to the BP at our institution between January 2009 and June 2024. Clinical characteristics, magnetic resonance imaging (MRI), F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) findings, and treatment outcomes were analyzed.
Seven patients (mean age, 50.3 years) were identified. The primary cancer diagnoses included invasive ductal carcinoma of the breast (n = 3), metaplastic carcinoma of the breast (n = 1), lung adenocarcinoma (n = 2), and papillary thyroid carcinoma (n = 1). The median time from the initial cancer diagnosis to PNTS symptom onset was 71.0 months. All patients initially presented with progressive unilateral pain or paresthesia, followed by motor weakness. Lower trunk plexopathy was the most common electrodiagnostic finding (n = 5). In most patients, BP MRI showed diffuse tubular enlargement and T2 hyperintensity throughout the BP (n = 6), with gadolinium enhancement primarily in the proximal regions (n = 7). F-FDG PET/CT demonstrated increased uptake in the BP, most prominently at the cervical spinal root or trunk levels (n = 6). Despite treatment, neurological outcomes were generally poor. Six of the seven patients died after a median follow-up of 19 months post-PNTS diagnosis.
PNTS to the BP can occur years after initial cancer diagnosis and may signify cancer progression. A high index of suspicion is crucial for timely diagnosis, particularly in patients with cancer and progressive upper extremity symptoms. Comprehensive imaging, including BP MRI and PET/CT, is essential for diagnosis. Despite treatment, prognosis remains poor, highlighting the need for improved diagnostic and therapeutic strategies.
神经周围肿瘤扩散（PNTS）至臂丛神经（BP）是一种罕见且具有挑战性的情况。本研究旨在阐明PNTS累及BP患者的临床表现、诊断挑战及预后。
我们回顾性分析了2009年1月至2024年6月在我院诊断为PNTS累及BP的患者。分析了临床特征、磁共振成像（MRI）、F-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）结果及治疗结局。
共纳入7例患者（平均年龄50.3岁）。原发癌诊断包括乳腺浸润性导管癌（n = 3）、乳腺化生性癌（n = 1）、肺腺癌（n = 2）和甲状腺乳头状癌（n = 1）。从最初癌症诊断到PNTS症状出现的中位时间为71.0个月。所有患者最初均表现为进行性单侧疼痛或感觉异常，随后出现运动无力。下干丛病变是最常见的电诊断结果（n = 5）。在大多数患者中，BP的MRI显示整个BP弥漫性管状增粗和T2高信号（n = 6），钆增强主要位于近端区域（n = 7）。F-FDG PET/CT显示BP摄取增加，最明显的是在颈神经根或干水平（n = 6）。尽管进行了治疗，但神经学结局总体较差。7例患者中有6例在PNTS诊断后中位随访19个月死亡。
PNTS累及BP可在最初癌症诊断数年之后发生，可能预示癌症进展。高度的怀疑指数对于及时诊断至关重要，尤其是对于有癌症且出现进行性上肢症状的患者。包括BP的MRI和PET/CT在内的综合影像学检查对于诊断必不可少。尽管进行了治疗，但预后仍然较差，这凸显了改进诊断和治疗策略的必要性。
