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Guerrero JR, Taghlabi KM, Meyer SA, Bhenderu LS, Sadrameli SS, Shkedy CI, Faraji AH, Rostomily RC. Melanoma metastasis to the femoral nerve: a novel case of melanoma masquerading as mononeuropathy. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22414. [PMID: 36443958 PMCID: PMC9705520 DOI: 10.3171/case22414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metastatic cancer may involve the central and peripheral nervous system, usually in the late stages of disease. At this point, most patients have been diagnosed and treated for widespread systemic disease. Rarely is the involvement of the peripheral nervous system the presenting manifestation of malignancy. One reason for this is a proposed "blood-nerve barrier" that renders the nerve sheath a relatively privileged site for metastases. OBSERVATIONS The authors presented a novel case of metastatic melanoma presenting as intractable leg pain and numbness. Further workup revealed concurrent disease in the brain and breast, prompting urgent treatment with radiation and targeted immunotherapy. LESSONS This case highlights the rare presentation of metastatic melanoma as a mononeuropathy. Although neurological complications of metastases tend to occur in later stages of disease after initial diagnosis and treatment, one must remember to consider malignancy in the initial differential diagnosis of mononeuropathy.
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Affiliation(s)
- Jaime R. Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
| | - Khaled M. Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
| | - Sara A. Meyer
- Department of Medical Education, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Saeed S. Sadrameli
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
| | - Clive I. Shkedy
- Department of Radiation Oncology, Houston Methodist Sugar Land Hospital, Sugar Land, Texas
| | - Amir H. Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
| | - Robert C. Rostomily
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
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2
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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3
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Makuszewska M, Fus Ł, Bartoszewicz R, Niemczyk K. Solitary breast cancer metastasis to the facial nerve. Breast J 2021; 27:838-840. [PMID: 34387907 DOI: 10.1111/tbj.14279] [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: 05/17/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
Facial nerve (FN) palsy, as a solitary symptom, resulting from metastatic tumor is not frequent. In this article, we report an unusual case of the breast cancer metastasis to the labyrinthine segment of a facial nerve.
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Affiliation(s)
- Maria Makuszewska
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Fus
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Robert Bartoszewicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
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4
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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5
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Musiienko AM, Alzahrani S, Simpson JAD, Heriot A, Warrier S. Colonic adenocarcinoma encasing the femoral nerve: complete surgical excision with preservation of function. ANZ J Surg 2016; 88:E464-E465. [PMID: 26749269 DOI: 10.1111/ans.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anton M Musiienko
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Saleh Alzahrani
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jonathan A D Simpson
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Satish Warrier
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Alfred Health, Prahan, Victoria, Australia
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6
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Grisold W, Grisold A. Cancer around the brain. Neurooncol Pract 2014; 1:13-21. [PMID: 26034610 DOI: 10.1093/nop/npt002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. METHODS A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. RESULTS The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. CONCLUSION In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.
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Affiliation(s)
- Wolfgang Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
| | - Anna Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
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Renal carcinoma relapse presenting as a peripheral nerve sheath tumor: A case report and brief review of the literature. Neurochirurgie 2013; 59:128-32. [PMID: 23806763 DOI: 10.1016/j.neuchi.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/02/2013] [Accepted: 04/11/2013] [Indexed: 11/20/2022]
Abstract
We report a rare case of renal carcinoma metastasis involving a lumbar nerve root. Metastases to nerve roots are rare occurrences, and to our knowledge, only six cases have been reported so far in the literature. The patient in this report presented with weakness in the right lower limb and intractable pain irradiating along the L5 dermatome. MRI findings revealed a right-sided L5 nerve root mass, suggestive of a schwannoma, involving the spinal ganglion and its extraforaminal region. Complete macroscopic resection of this mass was performed, and histopathologic analysis confirmed the lesion to be a metastasis of a renal clear cell carcinoma. Local radiotherapy was given and tyrosine kinase inhibitors administered. At 5 months, the patient was pain-free and his right limb weakness had completely resolved. A tumoral recurrence could be observed on the control MRI 5 months after surgery. This report presents the first case of a patient with a renal clear cell carcinoma metastasis to a L5 nerve root, as well as a brief review of previous cases of metastases to peripheral nerve roots.
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Neuropatie periferiche e cancri solidi. Neurologia 2012. [DOI: 10.1016/s1634-7072(12)63279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chawla J. Stepwise approach to myopathy in systemic disease. Front Neurol 2011; 2:49. [PMID: 21886637 PMCID: PMC3153853 DOI: 10.3389/fneur.2011.00049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/14/2011] [Indexed: 12/18/2022] Open
Abstract
Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.
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Affiliation(s)
- Jasvinder Chawla
- Chief of Neurology, Hines VA Hospital and Neurology Residency Program Director, Loyola University Medical Center Hines, IL, USA
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10
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Wong JYL, Seet JE, Khoo KL, Teo LLS. Mesothelioma Metastasising to The Sciatic Nerve. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n7p332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Ju Ee Seet
- National University Health System, Singapore
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11
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Chin KY, Fessas C, Murison M. A case report and review of soft tissue metastatic squamous cell carcinoma of the upper limb in the absence of a primary tumour. J Plast Reconstr Aesthet Surg 2009; 63:e568-70. [PMID: 19962361 DOI: 10.1016/j.bjps.2009.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 11/10/2009] [Accepted: 11/13/2009] [Indexed: 11/27/2022]
Abstract
Soft tissue metastases and distant perineural metastases of an unknown primary are rare presentations of cancer. We present a patient with soft tissue and intraneural metastatic squamous cell carcinoma to the left arm with unknown primary that was treated with wide excision, followed by adjuvant radiotherapy. The patient was followed up for 3 years, and has had no signs of recurrence. We discuss the management of this patient and review available literature to share our experience of managing this rare condition. Soft tissue and perineural metastases are rare, but should form part of the differential diagnosis in patients presenting with soft tissue (or nerve) swellings. To our knowledge, the presence of metastatic soft tissue SCC in the extremity with intraneural spread in the absence of a primary tumour has not been reported in the literature.
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Affiliation(s)
- Kuen Yeow Chin
- CT2 Surgery, Welsh Centre for Burns and Plastic Sugery, Morriston Hospital, Swansea, SA6 6NL, UK.
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12
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Life-threatening Neurological Complications in Patients with Malignancies. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Gachiani J, Kim DH, Nelson A, Kline D. Management of metastatic tumors invading the peripheral nervous system. Neurosurg Focus 2007. [DOI: 10.3171/foc.2007.22.6.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors present the results of a retrospective review of 37 surgically treated metastases to nerve (malignant peripheral non–neural sheath nerve tumors). Tumor frequencies, presentations, management, and prognosis are discussed.
Methods
Thirty-seven patients who were treated for metastases to nerve between 1969 and 2006 at the Louisiana State University Health Sciences Center were identified in a review of patient records. Notes regarding patient history and physical examination findings were reviewed to provide information on presenting symptoms and signs. Imaging and histopathological examination results were also reviewed. Cases were analyzed depending on the primary tumor and the location of metastasis.
Results
There included 37 surgically treated lesions, 16 of which originated in the breast and 10 of which originated in the lung. In two cases melanomas had metastasized to nerve, and one tumor each had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus.
Conclusions
The nervous system is involved in numerous ways by oncological process. Direct involvement of the peripheral nervous system occurs mostly from direct extension, although it occasionally occurs because of distant spread from the primary tumor to nerve. Surgical excision of the metastatic lesion with margins has been useful mostly in the control of pain. Nevertheless, patients eventually succumb to their primary malignancy.
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Affiliation(s)
| | - Daniel H. Kim
- 3Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Adriane Nelson
- 2Pathology, Louisiana State University Health Sciences Center
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14
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Abstract
Involvement of the peripheral nervous system (PNS) is common in patients with cancer and any part, including motor neurons, sensory ganglia, nerve roots, plexuses, cranial and peripheral nerves, and neuromuscular junctions, can be affected. Different mechanisms can initiate damage associated with cancer-related PNS disorders. These include tumour infiltration, toxicity of treatments, metabolic and nutritional perturbations, cachexia, virus infections, and paraneoplastic neurological syndromes. The type of cancer, lymphoma, or solid tumour is a further determinant of a PNS disorder. In this Review we discuss the different causes and mechanisms of disorders of the PNS in patients with cancer and we will focus on their assessment and diagnosis.
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