Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report

Capek, Stepan; Howe, Benjamin M.; Tracy, Jennifer A.; García, Joaquín J.; Amrami, Kimberly K.; Spinner, Robert J.

doi:10.3171/2014.12.jns141339

Cited by 22 publications

(13 citation statements)

References 23 publications

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“…8 We further hypothesize that cases of conus medullaris EM could be explained as an extension of the same process intradurally along the sacral and lumbar nerve roots, 20,44 possibly with subsequent intradural seeding 19 as proposed in perineural spread of prostate cancer. 10 …”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

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Sciatic nerve endometriosis (EM) is a rare presentation of retroperitoneal EM. The authors present 2 cases of catamenial sciatica diagnosed as sciatic nerve EM. They propose that both cases can be explained by perineural spread of EM from the uterus to the sacral plexus along the pelvic autonomie nerves and then further distally to the sciatic nerve or proximally to the spinal nerves. This explanation is supported by MRI evidence in both cases. As a proof of concept, the authors retrieved and analyzed the original MRI studies of a case reported in the literature and found a similar pattern of spread. They believe that the imaging evidence of their institutional cases together with the outside case is a very compelling indication for perineural spread as a mechanism of EM of the nerve.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

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“…Eight cases demonstrated dense tissue abnormality extending from the uterus to the sacral plexus, presumably an extension of EM along the pelvic autonomic nerves. We also theorized that EM can spread intradurally along the spinal nerves and possibly subsequently even seed within the cerebrospinal fluid as has been proposed in prostate cancer (Capek et al, 2015b). Presumably most cases of CNS EM would then involve the cauda equina and conus medullaris and EM of more distant structures would be superficial.…”

Section: Perineural Spread Theory -Anatomic Explanationmentioning

confidence: 99%

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

et al. 2015

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Endometriosis (EM) is an infrequent cause of peripheral neuropathy, most commonly sciatic. Perineural spread has recently been introduced as an alternate explanation for cases of lumbosacral or sciatic nerve EM. We performed a literature review to collect all reported cases of peripheral and central nervous system EM in search of anatomic patterns of involvement; potentially to support the perineural spread theory. If available, intraneural invasion and presence of peritoneal EM were recorded. The search revealed 83 articles describing 365 cases of somatic peripheral nervous EM and 13 cases of central nervous EM. The most frequently involved site was the sacral plexus (57%, n = 211), followed by the sciatic nerve (39%, n = 140). Other nerves were reported in significantly smaller numbers. Ninety seven percent (97%, n = 355) of peripheral nerve cases presented with pain, 20% (n = 72) reported weakness and 31% (n = 114), numbness. Thirty four percent (34%, n = 38) had solely intraneural EM of which 89% (n = 33) had no peritoneal EM (percentage based on available information). In the central nervous system, the conus medullaris and/or cauda equina constituted the majority of cases with 54% (n = 7). Apart from perineural spread, other discussed mechanisms include retrograde menstruation with peritoneal seeding, hematogenous and lymphogenous spread, stem cell implantation either hematogenously or via retrograde menstruation with subsequent EM differentiation, and coelomic or Müllerian duct metaplasia. We believe this literature review supports perineural spread as an alternate mechanism for EM of nerve, particularly the subgroup with intraneural EM and without peritoneal disease.

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“…Perineural spread of tumor from the organ to the lumbosacral plexus along the pelvic autonomic nerves has emerged as an alternate, logical explanation for select cases of neoplastic lumbosacral plexopathy (nLSP) in patients without extensive pelvic disease. This mechanism has been put forth for prostate, 9,17,27,37 bladder, 1 rectal, 18 and cervical cancer. 28 We reviewed our institutional series of cases concluded as perineural spread of pelvic malignancy in search of clinical and radiological patterns.…”

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Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns

Capek

Howe

Amrami

et al. 2015

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OBJECT Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist. METHODS The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. All available history, physical examination, electrodiagnostic studies, biopsy data and imaging studies, evidence of other metastatic disease, and follow-up were recorded in detail. The series was divided into 2 groups: cases with neoplastic lumbosacral plexopathy confirmed by biopsy (Group A) and cases included based on imaging characteristics despite the lack of biopsy or negative biopsy results (Group B). RESULTS Group A comprised 10 patients (mean age 69 years); 9 patients were symptomatic and 1 was asymptomatic. The L5–S1 spinal nerves and sciatic nerve were most frequently involved. Three patients had intradural extension. Seven patients were alive at last follow-up. Group B consisted of 7 patients (mean age 64 years); 4 patients were symptomatic, 2 were asymptomatic, and 1 had only imaging available. The L5–S1 spinal nerves and the sciatic nerve were most frequently involved. No patients had intradural extension. Four patients were alive at last follow-up. CONCLUSIONS The authors provide a unifying theory to explain lumbosacral plexopathy in select cases of various pelvic neoplasms. The tumor cells can use splanchnic nerves as conduits and spread from the end organ to the lumbosacral plexus. Tumor can continue to spread along osseous and muscle nerve branches, resulting in muscle and bone “metastases.” Radiological studies show a reproducible, although nonspecific pattern, and the same applies to clinical presentation.

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Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report

Cited by 22 publications

References 23 publications

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns

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