The Early Detection of Recurrence of Malignant Peripheral Nerve Sheath Tumor by Frequent Magnetic Resonance Imaging

Abstract

J Korean Neurosurg Soc 47 : [51][52][53][54] 2010 Surgery has a key role in the treatment of malignant peripheral nerve sheath tumors (MPNSTs), but the resectability of paraspinal MPNSTs is only 20%. Therefore, spinal MPNSTs show frequent recurrence and poor prognosis. Local recurrence is much more common than metastasis for MPNSTs, and surgery still has a key role in the treatment of local recurrence. Therefore, it is important that recurrence must be detected before resectability is lost. However, no evidence-based follow-up protocol has been established for MPNST. The authors performed gross total resection in a 34-year-old woman presented with thoracic MPNST. Adjuvant radiotherapy and chemotherapy were not administered since these adjuvant therapies generally do not improve survival in MPNST and may cause additional neurovascular damage. Instead, the authors monitored the primary site every 3 months using magnetic resonance imaging to detect local recurrence at the earliest opportunity. The tumor recurred locally on two occasions without overt symptoms at 21 and 24 months postoperatively. These recurrences were treated successfully by gross total removal.

The role of magnetic resonance imaging in the diagnostic evaluation of malignant peripheral nerve sheath tumors

“…[18] Our data and the results of previous authors suggest that MRI should be employed for pre-surgical planning and post-surgical surveillance of MPNSTs. Unless the lesion is invasive or metastatic, attempts to differentiate BPNSTs versus MPNSTs by means of MRI may be futile.…”

“…In addition, all lesions were evaluated for the presence of invasion of adjacent tissues (vessels, bones and/ or muscles) as well as for the presence of previously described characteristics of BPNSTs, such as tail sign, split-fat sign and target sign. [7,8] A thorough search through the patients' records was also performed for conventional radiographs and computed tomography (CT) scans, on which lesions were assessed for the presence of calcifications and for [18] fluorodeoxyglucose positron emission tomography combined with CT (FDG PET/CT) studies, on which the standardized uptake values (SUV max ) of the respective lesions were registered.…”

Favorable Outcome After Radical Resection and Subsequent Local Irradiation of Malignant Peripheral Nerve Sheath Tumor in the Cervical Spine

“…A patient with recurrent thoracic MPNST was followed for 14 months with no evidence of recurrence after achieving gross total removal. 23) In our case, a 25-year-old man has been free of relapse for 46 months after gross total removal. Radical resection remains the most effective treatment for MPNST in the spinal region, although the number of reported cases is still small.…”

“…[2][3][4][5]9,16,21,23,26,27) There were 6 male and 6 female patients, and ages at diagnosis ranged from 25 to 75 years, with a mean of 41 years. Only 3 cases had clear evidence of NF-1.…”

“…12,13) There have been only isolated reports of the development of MPNSTs after irradiation and primary or metastatic MPNSTs in the spinal region. [2][3][4][5]9,16,21,23,26,27) Therefore, the clinical features and outcomes of spinal MPNSTs remain unclear.…”