1
|
Honda Y, Sekine T, Kimata R, Motoda N, Takahashi K, Yamane A, Yasui D, Kodani E, Ichikawa T, Kumita S. Early and Post-Treatment Imaging Findings in Perineural Spread: A Pathway to Diffuse Muscle Metastasis in Recurrent Bladder Carcinoma. J NIPPON MED SCH 2024; 91:333-338. [PMID: 36823118 DOI: 10.1272/jnms.jnms.2024_91-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Perineural spread (PNS) from pelvic carcinoma has been regarded as a pathway to muscle and bone metastasis. However, few cases have been reported, especially in patients with bladder carcinoma. In the present report, we discuss a case of diffuse cancer involvement in the muscle 5 years after radical cystectomy for advanced bladder carcinoma. Careful observation of temporal changes on medical images confirmed PNS as the pathway to muscle metastasis (i.e., primary PNS). Our report presents early and post-treatment CT, MRI and FDG-PET/CT findings of PNS from the bladder carcinoma.
Collapse
Affiliation(s)
- Yoshimitsu Honda
- Department of Radiology, Nippon Medical School
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Ryoji Kimata
- Department of Urology, Nippon Medical School Musashi Kosugi Hospital
| | - Norio Motoda
- Department of Diagnostic Pathology, Nippon Medical School Musashi Kosugi Hospital
| | - Keigo Takahashi
- Department of Urology, Nippon Medical School Musashi Kosugi Hospital
| | - Aya Yamane
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Eigo Kodani
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Taro Ichikawa
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | | |
Collapse
|
2
|
Patwardhan MV, Mahendran R. The Bladder Tumor Microenvironment Components That Modulate the Tumor and Impact Therapy. Int J Mol Sci 2023; 24:12311. [PMID: 37569686 PMCID: PMC10419109 DOI: 10.3390/ijms241512311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The tumor microenvironment (TME) is complex and involves many different cell types that seemingly work together in helping cancer cells evade immune monitoring and survive therapy. The advent of single-cell sequencing has greatly increased our knowledge of the cell types present in the tumor microenvironment and their role in the developing cancer. This, coupled with clinical data showing that cancer development and the response to therapy may be influenced by drugs that indirectly influence the tumor environment, highlights the need to better understand how the cells present in the TME work together. This review looks at the different cell types (cancer cells, cancer stem cells, endothelial cells, pericytes, adipose cells, cancer-associated fibroblasts, and neuronal cells) in the bladder tumor microenvironment. Their impact on immune activation and on shaping the microenvironment are discussed as well as the effects of hypertensive drugs and anesthetics on bladder cancer.
Collapse
Affiliation(s)
| | - Ratha Mahendran
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| |
Collapse
|
3
|
Lumbosacral plexopathy caused by the perineural spread of pelvic malignancies: clinical aspects and imaging patterns. Acta Neurochir (Wien) 2022; 164:1509-1519. [PMID: 35445854 DOI: 10.1007/s00701-022-05194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Perineural spread (PNS) of tumors from pelvic malignancies is a rare phenomenon but constitutes an important differential diagnosis of lumbosacral plexopathy (LSP). Herein, we describe the clinical and imaging features of patients with LSP due to PNS of pelvic malignancies along with a literature review. METHODS We retrospectively reviewed 9 cases of LSP caused by PNS of pelvic malignancy between January 2006 and August 2021, and all clinical and imaging parameters were recorded in detail. Clinical symptoms and signs of patients were described and listed in the order in which they occurred. The results of imaging test were analyzed to describe specific findings in LSP caused by PNS. RESULTS This study enrolled nine adult patients (mean age, 50.1 years). Two cases initially presented as LSP and were later diagnosed with pelvic malignancy. Pain in the perianal or inguinal area preceded pain at the extremities in six patients. Neurogenic bladder or bowel symptoms developed in five patients. On the magnetic resonance imaging (MRI), the S1-S2 spinal nerve was most commonly involved, and S1 myotome weakness was more prominent in six patients than the other myotomes. One patient had an intradural extension. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) showed abnormal signal intensity in six patients. No abnormality in 18F-FDG PET/CT was detected in the nervous structures in one patient. Only four patients survived until the last follow-up visit. CONCLUSIONS Though rare, physicians should always keep in mind the possibility of LSP due to the PNS in patients with pelvic malignancy. Thorough physical examination and history taking could provide clues for diagnosis. Pelvic MRI and 18F-FDG-PET/CT should be considered for patients with LSP to rule out neoplastic LSP.
Collapse
|
4
|
Luna R, Fayad LM, Rodriguez FJ, Ahlawat S. Imaging of non-neurogenic peripheral nerve malignancy-a case series and systematic review. Skeletal Radiol 2021; 50:201-215. [PMID: 32699955 DOI: 10.1007/s00256-020-03556-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the frequency, clinico-pathologic and imaging features of malignant tumors in peripheral nerves which are of non-neurogenic origin (non-neurogenic peripheral nerve malignancy-PNM). MATERIALS AND METHODS We retrospectively reviewed our pathology database for malignant peripheral nerve tumors from 07/2014-07/2019 and performed a systematic review. Exclusion criteria were malignant peripheral nerve sheath tumor (MPNST). Clinico-pathologic and imaging features, apparent diffusion coefficient (ADCmin), and standard uptake values (SUVmax) are reported. RESULTS After exclusion of all neurogenic tumors (benign = 196, MPNST = 57), our search yielded 19 non-neurogenic PNMs (7%, n = 19/272), due to primary intraneural malignancy (16%, n = 3/19) and secondary perineural invasion from an adjacent malignancy (16%, n = 3/19) or metastatic disease (63%, n = 12/19). Non-neurogenic PNMs were located in the lumbosacral plexus/sciatic nerves (47%, n = 9/19), brachial plexus (32%, n = 6/19), femoral nerve (5%, n = 1/19), tibial nerve (5%, n = 1/19), ulnar nerve (5%, n = 1/19), and radial nerve (5%, n = 1/19). On MRI (n = 14/19), non-neurogenic PNM tended to be small (< 5 cm, n = 10/14), isointense to muscle on T1-W (n = 14/14), hyperintense on T2-WI (n = 12/14), with enhancement (n = 12/12), low ADCmin (0.5-0.7 × 10-3 mm2/s), and variable metabolic activity (SUVmax range 2.1-13.1). A target sign was absent (n = 14/14) and fascicular sign was rarely present (n = 3/14). Systematic review revealed 89 cases of non-neurogenic PNM. CONCLUSION Non-neurogenic PNMs account for 7% of PNT in our series and occur due to metastases and primary intraneural malignancy. Although non-neurogenic PNMs exhibit a non-specific MRI appearance, they lack typical signs of neurogenic tumors such as the target sign. Quantitative imaging features identified by DWI (low ADC) and F18-FDG PET/CT (high SUV) may be helpful clues to the diagnosis.
Collapse
Affiliation(s)
- Rodrigo Luna
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Pathology - Neuropathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
5
|
Song EJ, Park JS, Ryu KN, Park SY, Jin W. Perineural Spread Along Spinal and Obturator Nerves in Primary Vaginal Carcinoma: A Case Report. World Neurosurg 2018; 115:85-88. [PMID: 29660549 DOI: 10.1016/j.wneu.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Perineural spread is not an uncommon feature in carcinoma of the head and neck. On the contrary, perineural spread in pelvic malignancies has been rarely reported. This is the first report on perineural spread of the obturator nerve and the lumbosacral plexus from primary vaginal cancer. CASE DESCRIPTION A 50-year-old woman diagnosed with infectious spondylitis at an outside hospital was referred to our institution. She presented with persistent lower back pain and right anterior thigh pain. Magnetic resonance imaging and subsequent 18F-fluorodeoxyglucose-positron emission tomography/computed tomography revealed primary vaginal cancer with metastatic lymphadenopathy and perineural spread of the lumbosacral plexus, including L3, L4 nerve roots and branches, and obturator nerve along with soft tissue masses in the right psoas and proximal adductor muscles. CONCLUSIONS Clinical diagnosis of perineural spread in pelvic malignancies is difficult to establish, as it has nonspecific symptoms as an initial manifestation. Clinicians should recognize the possibility of perineural spread of malignancies if radiologic findings, such as thickening of lumbosacral nerves and perineural mass, are observed on magnetic resonance imaging. Further evaluation is necessary to detect possible pelvic malignancy and differentiate from other diseases.
Collapse
Affiliation(s)
- Eun Jee Song
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital, Gangdong, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital, Gangdong, Seoul, Republic of Korea
| |
Collapse
|
6
|
Jacobs JJ, Capek S, Spinner RJ, Swanson KR. Mathematical model of perineural tumor spread: a pilot study. Acta Neurochir (Wien) 2018; 160:655-661. [PMID: 29264779 DOI: 10.1007/s00701-017-3423-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Perineural spread (PNS) of pelvic cancer along the lumbosacral plexus is an emerging explanation for neoplastic lumbosacral plexopathy (nLSP) and an underestimated source of patient morbidity and mortality. Despite the increased incidence of PNS, these patients are often times a clinical conundrum-to diagnose and to treat. Building on previous results in modeling glioblastoma multiforme (GBM), we present a mathematical model for predicting the course and extent of the PNS of recurrent tumors. METHODS We created three-dimensional models of perineurally spreading tumor along the lumbosacral plexus from consecutive magnetic resonance imaging scans of two patients (one each with prostate cancer and cervical cancer). We adapted and applied a previously reported mathematical model of GBM to progression of tumor growth along the nerves on an anatomical model obtained from a healthy subject. RESULTS We were able to successfully model and visualize perineurally spreading pelvic cancer in two patients; average growth rates were 60.7 mm/year for subject 1 and 129 mm/year for subject 2. The model correlated well with extent of PNS on MRI scans at given time points. CONCLUSIONS This is the first attempt to model perineural tumor spread and we believe that it provides a glimpse into the future of disease progression monitoring. Every tumor and every patient are different, and the possibility to report treatment response using a unified scale-as "days gained"-will be a necessity in the era of individualized medicine. We hope our work will serve as a springboard for future connections between mathematics and medicine.
Collapse
|
7
|
Spinner RJ, Capek S. Adapting Findings From Rare Peripheral Nerve Disorders Can Lead to Broad Applications in Neurosurgery. Neurosurgery 2017; 64:52-58. [DOI: 10.1093/neuros/nyx306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Stepan Capek
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
8
|
Gupta L, Yadav M, Thulkar S. 'Trident sign' in pelvis: sinister sign with poor prognosis. BMJ Case Rep 2017; 2017:bcr-2017-220460. [PMID: 28784885 DOI: 10.1136/bcr-2017-220460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The perineural spread of the cancer through the lumbosacral plexus gives an appearance of 'trident sign' on contrast-enhanced CT scan and MRI. It is associated with adverse survival rates and carries a poor prognostic value.
Collapse
Affiliation(s)
- Laxmikant Gupta
- Department of Radiodiagnosis and Imaging, BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Yadav
- Department of Radiodiagnosis and Imaging, BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis and Imaging, BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Perrin H, Brunner P, Ortega JC, Mercier B, Clement N, Robino C, Chazal M. Robotic resection of an obturator schwannoma with preservation of normal nerve fascicles and function. J Robot Surg 2017; 11:479-483. [PMID: 28343319 DOI: 10.1007/s11701-017-0693-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/19/2017] [Indexed: 02/03/2023]
Abstract
An asymptomatic pelvic tumor was incidentally found in a 27-year-old man. A CT-guided needle biopsy with a pathologic examination confirmed the diagnosis of a benign schwannoma. We describe the complete robotic resection with the conservation of normal fascicles. The postoperative course was uneventful. No neurological deficit occurred, and the electromyogram was normal 6 weeks and 7 months later.
Collapse
Affiliation(s)
- Hubert Perrin
- Department of Digestive and General Surgery, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco.
| | - Philippe Brunner
- Department of Radiology, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| | - Jean Claude Ortega
- Department of Urology, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| | - Bertrand Mercier
- Department of Nephrology and Neurology, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| | - Nathalie Clement
- Department of Pathology, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| | - Christophe Robino
- Department of Nephrology and Neurology, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| | - Maurice Chazal
- Department of Digestive and General Surgery, Princess Grace Hospital, Pasteur Avenue, Principality of Monaco, 98000, Monaco
| |
Collapse
|
10
|
Capek S, Krauss WE, Amrami KK, Parisi JE, Spinner RJ. Perineural Spread of Renal Cell Carcinoma: A Case Illustration with a Proposed Anatomic Mechanism and a Review of the Literature. World Neurosurg 2016; 89:728.e11-7. [DOI: 10.1016/j.wneu.2016.01.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/21/2022]
|
11
|
Capek S, Amrami KK, Spinner RJ. Gastroesophageal junction carcinoma and brachial plexopathy: An anatomic explanation via perineural spread. Clin Anat 2016; 29:800-3. [DOI: 10.1002/ca.22708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Stepan Capek
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
| | - Kimberly K. Amrami
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
- Department of Radiology; Mayo Clinic; Rochester Minnesota
| | | |
Collapse
|
12
|
Capek S, Howe BM, Froemming AT, Amrami KK, Spinner RJ. Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread. A report of two cases. Skeletal Radiol 2015; 44:1365-70. [PMID: 25862336 DOI: 10.1007/s00256-015-2143-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Stepan Capek
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | |
Collapse
|
13
|
Capek S, Howe BM, Amrami KK, Spinner RJ. Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus 2015; 39:E14. [DOI: 10.3171/2015.7.focus15209] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- Stepan Capek
- Departments of 1Neurosurgery and
- 22nd Faculty of Medicine, Charles University in Prague, Czech Republic
| | | | | | | |
Collapse
|
14
|
Siquara de Sousa AC, Capek S, Howe BM, Jentoft ME, Amrami KK, Spinner RJ. Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurg Focus 2015; 39:E15. [DOI: 10.3171/2015.6.focus15208] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Stepan Capek
- Departments of 1Neurosurgery,
- 5International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
| | | | | | | | | |
Collapse
|