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Li H, Wang L, Wu YH, Chen G, Li HX, Fan LF, Gu M, Jiang CH. Malignant peripheral nerve sheath tumor with hemophilic syndrome and bone marrow fibrosis: A rare case report. World J Clin Cases 2023; 11:7673-7679. [DOI: 10.12998/wjcc.v11.i31.7673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Malignant schwannoma is a rare tumor in the peripheral nervous system, accounting for approximately 5% to 10% of systemic soft tissue sarcomas. Especially, malignant schwannoma occurring in the broad ligament of the uterus with hemophilic syndrome and bone marrow fibrosis is extremely rare in clinical practice. Here, we report the first case of an patient diagnosed with malignant peripheral nerve sheath tumor (MPNST) of the broad ligament of the uterus with hemophilic syndrome and bone marrow fibrosis, and share our reference clinical diagnosis and treatment experience.
CASE SUMMARY A patient was diagnosed with MPNST of the uterus harboring hemophilic syndrome and bone marrow fibrosis. She received combination, and repeated imaging revealed further encountered rare complications (hemophilia syndrome and bone marrow fibrosis) after two cycles of chemotherapy. Thereafter, combined treatment with pazopanib, gemcitabine, and dacarbazine was initiated. Unfortunately, the patient succumbed to death at hospital after two weeks.
CONCLUSION This report firstly provided reference clinical practice for a patient with MPNST of the uterus harboring hemophilic syndrome and bone marrow fibrosis. Our case raises a reminder about the tolerance and safety of combination therapy, especially in young women.
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Affiliation(s)
- Hui Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Li Wang
- Department of Pathology, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Ying-Hong Wu
- Department of Neurology, Baogang Hospital, Baotou 014010, Inner Mongolia Autonomous Region 014010, China
| | - Gang Chen
- Department of Pharmacy, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Hong-Xia Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Li-Fen Fan
- Department of Orthopedics, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Min Gu
- Department of Medical Oncology, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Cai-Hong Jiang
- Department of Medical Oncology, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
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Mirzashahi B, Razzaghof M, Tabatabaei Irani P. Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature. Clin Case Rep 2023; 11:e7098. [PMID: 36992677 PMCID: PMC10041379 DOI: 10.1002/ccr3.7098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/15/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
We report a case of cauda equina syndrome (CES) caused by an epidural metastasis of breast cancer, which oddly mimicked a large disc sequestrum leading to misdiagnosis. To our knowledge, it is the first report of a metastatic epidural breast cancer lesion mimicking a disc sequestrum. Any clinician should be cautious when confronting the manifestations of lumbar disc herniation in a patient with a history of breast cancer. Epidural metastasis of breast cancer can mimic the radiologic and clinical features of a disc sequestrum.
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Affiliation(s)
- Babak Mirzashahi
- Orthopedic Spine Surgeon, Joint Reconstruction Research Center (JRRC)Tehran University of Medical SciencesTehranIran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC)Tehran University of Medical SciencesTehranIran
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Ariafar A, Ahmed F, Hosseini SH, Khorshidi A, Torabi-Nezhad S. Intrapelvic malignant nerve sheath tumors presenting as acute urinary retention: A case report and literature review. Clin Case Rep 2022; 10:CCR36266. [PMID: 35999978 PMCID: PMC9388834 DOI: 10.1002/ccr3.6266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Malignant nerve sheath tumors (MPNSTs) are rare sarcomas tumors which rarely present as intrapelvic mass and are hard to diagnose clinically. We present a 29-year-old male patient presented with acute urinary retention and was diagnosed with large intrapelvic mass. After complete surgical resection, the histopathology confirmed the diagnosis of low MPNST.
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Affiliation(s)
- Ali Ariafar
- Department of Urology School of Medicine, Shiraz University of Medical Sciences Shiraz Iran.,Urology Oncology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Faisal Ahmed
- Department of Urology Al-Thora General Hospital, School of Medicine, Urology Research Center, Ibb University of Medical Sciences Ibb Yemen
| | - Seyed Hossein Hosseini
- Department of Urology School of Medicine, Shiraz University of Medical Sciences Shiraz Iran
| | - AbdolAzim Khorshidi
- Department of Urology, Dena Hospital School of Medicine, Shiraz University of Medical Sciences Shiraz Iran
| | - Simin Torabi-Nezhad
- Department of Pathology Dena Hospital, School of Medicine, Shiraz University of Medical Sciences Shiraz Iran
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Zhao L, Wei J, Wan C, Han S, Sun H. The diagnostic pitfalls of lumbar disc herniation---- malignant sciatic nerve tumour: two case reports and literature review. BMC Musculoskelet Disord 2021; 22:848. [PMID: 34610793 PMCID: PMC8493725 DOI: 10.1186/s12891-021-04728-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background Sciatica pain is a typical symptom of lumbar disc herniation (LDH), but some neurogenic and malignant tumours surrounding the sciatic nerve can also cause similar symptoms. These tumours are often misdiagnosed or even mistreated as LDH in clinical practice. Case presentation In our clinical practice, we found two patients with malignant tumours who were misdiagnosed with LDH. One patient complained of pain and numbness in the right lower limb. The primary diagnosis was LDH, and the patient underwent posterior lumbar interbody fusion surgery. After the operation, the symptoms were not alleviated. Then, diffuse large B-cell lymphoma involving the soft tissue and the sciatic nerve was identified. Another patient who manifested with radiating pain in the right lower limb was diagnosed with LDH at Chengde Central Hospital. He received regular conservative treatment for approximately 6 months, but his symptoms were not relieved, and then he was referred to our hospital. A malignant peripheral nerve sheath tumour (MPNST) of the sciatic nerve was diagnosed, and he received cisplatin (DDP) chemohyperthermia. Conclusions Descriptions of tumour lesions involving the sciatic nerve and misdiagnosed as LDH in the literature are rare. In the reported literature, 7 patients were misdiagnosed with LDH, and all patients presented with sciatica. Among them, 4 patients only received surgical treatment, 1 patient only underwent neurolysis, and 2 patients received both surgical and chemotherapy treatment. Their low incidence and similar clinical manifestations to LDH make malignant tumours involving the sciatic nerve easy to misdiagnose. When the clinical symptoms and signs are inconsistent with the imaging findings, we need to be aware of non-discogenic sciatica, including tumours involving the sciatic nerve. Furthermore, tumours that grow near the exit of the sciatic notch may be misdiagnosed because of their deeper location and because they are covered with gluteal muscles. Sometimes sciatica caused by sciatic nerve tumours is only distal, without any radicular distribution. This pain is more severe than that caused by LDH, and this pain is not related to the position of the lumbar spine. Thus, it is beneficial to perform a detailed physical examination of the sciatic nerve to avoid this kind of misdiagnosis.
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Affiliation(s)
- Li Zhao
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Junqiang Wei
- Department of Traumatic Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde, Hebei, 067000, China.
| | - Chenguang Wan
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin, 300000, China
| | - Shuhong Han
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - He Sun
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China.
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Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain 2020; 33:305-317. [PMID: 32989195 PMCID: PMC7532296 DOI: 10.3344/kjp.2020.33.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don’t know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Physical Medicine and Rehabilitation Department, Brahmanbaria Medical College, Brahmanbaria, Bangladesh.,School of Health Sport and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Suzon Al Hasan
- Physical Medicine and Rehabilitation Department, Rajshahai Medical College, Rajshahai, Bangladesh
| | - Johannes J Rasker
- Faculty of Behavioral Management and Social Sciences, Psychology Health and Technology, University of Twente, Enschede, The Netherlands
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Champeaux C, Abi-Lahoud G, Larousserie F. An odd and serious "disc bulging"! Neurochirurgie 2019; 65:187-190. [PMID: 31100350 DOI: 10.1016/j.neuchi.2019.04.001] [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: 08/21/2018] [Revised: 11/16/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Cauda equina syndrome is a common acute medical condition, usually caused by large degenerative disc herniation or metastatic lumbar disease. We describe a patient who presented with a lesion featuring both discal and tumoral characteristics. CLINICAL PRESENTATION A 41-year-old woman presented with ongoing back pain, progressive lower-limb weakness and sphincter disorder. Magnetic resonance imaging showed a very odd-looking large anterior epidural lesion originating from the L3-L4 space and severely compressing the roots of the cauda equina. Partial surgical decompression was performed in emergency. At a later time, redo surgery was performed to maximize resection, and was unfortunately followed by several complications. After 6 surgical procedures including a ventriculo-peritoneal shunt insertion and intensive rehabilitation, the patient could walk independently with the aid of one crutch. Following collegial review, the diagnosis of low-grade chondrosarcoma of the intervertebral disc was suggested. CONCLUSION We report on a very unusual and therapeutically challenging spinal tumor diagnosed as low-grade chondrosarcoma of discal origin, an entity never previously described.
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Affiliation(s)
- C Champeaux
- Department of neurosurgery, Lariboisière hospital, 75010 Paris, France; Department of neurosurgery, Sainte-Anne hospital, 75014 Paris, France; Department of neurosurgery, NHNN, university college London hospitals, NHS foundation trust, WC1N 3BG London, UK.
| | - G Abi-Lahoud
- Department of neurosurgery, Lariboisière hospital, 75010 Paris, France
| | - F Larousserie
- Département de pathologie, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
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