Sciatic neuropathy as first sign of metastasising prostate cancer

Hansen, Jakob Møller; Rasti, Zoreh; Smith, Torben; Lassen, LH

doi:10.1136/bcr.12.2009.2529

Cited by 5 publications

(5 citation statements)

References 18 publications

(15 reference statements)

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“…Perineural spread along the muscle and osseous nerve branches has been proposed as an alternate explanation for muscle 15 and bone 16 metastases. This mechanism could explain cases of prostate cancer with nerve symptoms and regional bone metastases, 26,50,70 or bladder with muscle mestastases. 47 Although muscle is by nature very resistant to metastasis, 60 in these patients the resistance may decrease as the muscle becomes denervated.…”

Section: Perineural Spread Beyond the Lumbosacral Plexusmentioning

confidence: 96%

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

Capek

Howe

Amrami

et al. 2015

FOC

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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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Section: Perineural Spread Beyond the Lumbosacral Plexusmentioning

confidence: 96%

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

Capek

Howe

Amrami

et al. 2015

FOC

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“…Hansen et al [18] described a patient with prostate cancer with perineural spread to the right sciatic nerve who had metastatic disease in the right pubic bone and right ischium. Paulson [19] reported ten cases of neoplasms of the bony pelvis producing sciatica, two of which are of interest; one patient with prostate cancer and neurologic symptoms had metastasis in the right sacrum, and another patient with prostate cancer who presented with progressive bilateral leg weakness and sciatica was found to have metastases in the right acetabulum, right sacrum, right L2 body and left ilium.…”

Section: Discussionmentioning

confidence: 98%

“…The biopsy of the left sciatic nerve confirmed perineural tumor spread. During the evaluation the patient had extensive imaging including an 11 C-choline PET/CT scan, 18 F-deoxy-glucose PET/CT (FDG PET/CT) scan and MRI of the pelvis at 3 T. The 11 C-choline PET/CT scan demonstrated a metastatic lesion in the sacral portion of the left sacroiliac joint, one in the sacrum at the S3 level, two in the left ischial tuberosity and one in each inferior pubic ramus. The multiparametric MRI assessing dynamic gadolinium enhancement confirmed the neoplastic nature of the pelvic lesions (Fig.…”

Section: Case Reportsmentioning

confidence: 99%

Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread. A report of two cases

et al. 2015

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We propose that pelvic malignancies can spread to bone and cause bony metastases using nerves as conduits. We reviewed two cases of pelvic malignancy with perineural spread of bladder cancer and prostate cancer. In a patient with prostate cancer, we identified six lesions that were positive on the (11)C-choline PET/CT scan and MRI; in a patient with bladder cancer, we identified two lesions positive on the (18)F-deoxy-glucose PET/CT scan and MRI. We carefully reviewed the imaging studies, and using established sclerotome maps we identified spinal nerves supplying each of eight pelvic bony lesions. All these spinal nerves showed evidence of tumor infiltration with extension toward the affected bones. We theorize that perineural tumor spread may serve as an additional mechanism of pelvic osseous metastases in pelvic malignancies.

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“…Furthermore, CPN compression at the fibular head may result in sensory and/or motor impairments, including foot drop. Neoplastic lumbosacral plexopathy due to colon cancer, prostate cancer, or gastric cancer, could each initially mimic lumbago with sciatica, thus demanding meticulous laboratory and imaging work-up [ 98 - 100 ].…”

Section: Main Bodymentioning

confidence: 99%

“…In our recent study, an example of extra-spinal sciatica, namely PS, was seen almost with equal frequency both in men and women, being slightly more common in housewives [ 7 ]. Sciatica also is reported as emerging from pathology in the vicinity of the inferior gemellus muscle, such as hip adductor muscle tear(s), wallet neuritis, ossified bone tissue (hip/femur), piriformis pyomyositis, SN endometriosis, SN tumor, malignant invasion to SN, and cluneal nerve disorder [ 8 - 12 ]. Amongst others, osteitis condensans ilii (OCI), inflammatory sacroiliitis, referred pain from the quadratus lumborum (QL) muscle, myofascial pain syndrome, meralgia paraesthetica, gluteal medius (GME) tendinitis, post-injectional gluteal neuropathy, also mimic sciatica [ 7 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Extra-spinal sciatica and sciatica mimics: a scoping review

et al. 2020

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'chondromas' of the spine, which were on display in the Harvard medical school pathology museum. The presence of pain was initially, and often still is, ascribed to pressure on nerve roots. In 1956, Kelly believed that pressure on a nerve would lead to loss of function and not to pain. Later, Lindahl and Rexed (1996) reported findings from laminectomy, proving that the inflammatory response of injured nerve roots caused by prolapsed lumbar intervertebral disc (PLID), led to development of sciatica-type pain [1]. Lumbago means low back pain (LBP), and mostly exists

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Sciatic neuropathy as first sign of metastasising prostate cancer

Cited by 5 publications

References 18 publications

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

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

Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread. A report of two cases

Extra-spinal sciatica and sciatica mimics: a scoping review

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