Perineural tumor spread — Interconnection between spinal and cranial nerves

Kozić, Duško; Njagulj, Vesna; Popadic-Gacesa, Jelena; Stoehr, Robert; Prvulović, Nataša

doi:10.1016/j.jns.2012.08.023

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…The spread of the tumor usually follows a retrograde (toward the central nervous system) direction, meaning that the skull base, the cranial foramina, and even intracranial structures can be affected. 8,13,17,18 As in this case, anterograde spread can also occur. Approximately 40% of patients with perineural spread remain asymptomatic, 18 making the diagnosis challenging.…”

Section: Postoperative Coursementioning

confidence: 81%

“…10,19 Two cases of spinal nerve involvement have been reported. 14,21 There are also several cases of melanoma involving the brachial plexus but from soft-tissue nodal compression 7,13 or an unspecified mechanism 12 rather than perineural spread. This is the first known example in the literature describing a mechanism by which perineural spread of melanoma extends from a cranial nerve to the cervical and brachial plexuses.…”

Section: Postoperative Coursementioning

confidence: 99%

See 1 more Smart Citation

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

Restrepo¹,

Spinner²,

Howe

et al. 2015

JNS

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P erineural spread is increasingly recognized as a relatively common mechanism of metastasis in many types of malignancies, particularly those involving the head and neck region. This mechanism of tumor spread for metastatic melanoma is well known to occur along the cranial nerves and cervical plexus. 4,9,14,[16][17][18] We describe a rare example of documented perineural spread of melanoma, arising in the mandible and extending along a cranial nerve, the cervical plexus, and into the brachial plexus. We correlate the clinicoradiological features and propose an anatomopathological explanation to support the mechanism of perineural spread in this case. case report HistoryA 48-year-old right-handed woman presented in 2010 with a several-month history of progressive numbness, tingling, itching, and atrophy affecting the skin and muscles of the right neck. MRI of the cervical spine revealed right C2-3 and C3-4 foraminal masses (Fig. 1 left). The patient underwent observation. Repeat MRI performed 7 months later showed spinal cord displacement at the level of C-2 ( Fig. 1 right). The patient underwent an open biopsy-the findings of which were consistent with a neurofibromaand 1 week later, C2-4 laminectomy, decompression, and fusion. The lesion was partially resected. Postoperatively, the patient received 45-Gy radiotherapy to a field from the top of C-2 to the bottom of C-6, including the spinal cord as well as an 18-Gy boost to the right-sided upper cervical roots and nerves. Brain MRI findings at that time were normal. The brachial plexus was not imaged.Over the next 2 years the patient had persistent cervical discomfort and progressive pain in her right shoulder and then the biceps region. Neither partial removal of the instrumentation nor steroid injections provided relief of her pain, which progressed as time passed. In 2013 she was evaluated at a tertiary care facility when she noted weakness in shoulder abduction and external rotation. Imaging now revealed plexiform lesions involving multiple cervical nerves and the upper brachial plexus. Pathological specimens were reviewed and the findings were interpreted as hybrid schwannoma/neurofibroma. The patient was thought to have a segmental form of schwannomatosis.The patient had a history of melanoma. In 2001, she had a lesion excised from her trunk with no local recurrence. In 2004, she had a nearly 2-cm lesion excised from the angle of the right jaw, a fusion of lentigo maligna and desmoplastic types. It was invasive to Clark's Level IV 5 and Breslow's 3 depth 3 mm.The mitotic rate was 0. Local perineural invasion was evident in the specimen. Tumor was present at the biopsy margins. The BRAF was wild type. Findings from the sentinel cervical lymph node biopsy were negative. Physical ExaminationIn February 2014, the patient presented to our institution. Physical examination revealed atrophic right neck Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in th...

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Section: Postoperative Coursementioning

confidence: 81%

Section: Postoperative Coursementioning

confidence: 99%

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

Restrepo¹,

Spinner²,

Howe

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…El plexo cervical es una estructura formada por la división anterior de los cuatro primeros nervios cervicales 40 . Inerva la región postauricular (nervio auricular mayor) 41 y anterosuperior del cuello, y da lugar a numerosas ramas para las estructuras musculares profundas, como el asa cervical y el nervio frénico.…”

Section: Otros Pares Craneales Y El Plexo Cervicalunclassified