Pelvic radiculopathies, lumbosacral plexopathies, and neuropathies in oncologic disease: a multidisciplinary approach to a diagnostic challenge

Abstract

The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge.

Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

“… 12 Positron emission tomography (rule out tumor/metastatic LSP) and electromyography (low-amplitude motor unit potentials in RILSP) are helpful adjunct tools, along with MRI. 13 , 14 To the best of our knowledge, this is the first study that has sought LSP contouring and its correlation with RILSP in patients with cervical cancer ( Table 4 ).…”

Clinical Reasoning: A 59-year-old woman with multiple myeloma and lower extremity weakness and numbness

“…However, malignant lumbosacral plexopathy is typically unilateral, and these patients generally experience pain (more pronounced at night) before developing weakness, numbness, and diminished/absent reflexes. 1 Also, if the patient had injury to the lumbosacral plexi, irrespective of the etiology, one would expect a more pronounced and asymmetric sensory pattern instead of solely distal lower extremity numbness.…”

Fetal topography of arteries and nerves of muscles of the medial femoral group

“…However, the peculiarities of the intramuscular distribution of nerves and arteries in the muscles of the lower limb are currently presented quite insufficiently in the most common guidelines on neurology, vascular surgery, traumatology and orthopedics [9][10][11][12] . In the available sources there is practically no information about the fetal topography of the vessels and nerves of the muscles of the lower extremities, and in particular of the thigh.…”