1534 A rare operation: resection of a complex malignant peripheral nerve sheath tumour deemed inoperable by a national centre

We present this rare case which was led by spinal surgeons at Leeds after being deemed not suitable for operative input by a national centre.

A 54-year-old lady who presented with 2-month history of worsening left flank pain on a background of four years. She was otherwise fit and well. CT confirmed aggressive left-sided paraspinal tumour with epidural encroachment, extending from T8 to T10 vertebral levels. Its deep surface was well-defined and extending superficially through the chest wall with destruction of ribs. The mass grew in size in course of days requiring urgent attention due to risk of cord compression. Biopsy proved high grade MPNST.

Malignant peripheral nerve sheath tumor (MPNST) is a rare type of sarcoma, 5-10% of sarcoma cases. MPNST is most common in young adults and middle-aged adults. About 25% to 50% of people with MPNST have NF1. 8% to 13% of people with NF1 will get MPNST in their lifetime.

An MDT approach involving spinal, thoracic, vascular and plastic surgeons opined it requiring extensive surgery due to its complexity. It was performed in stages – embolisation then aortic stent placement followed by final resection of the tumour with chest well reconstruction using an LD flap.

A multidisciplinary and multispecialty approach has led to a positive prognosis for this patient who is on the road to recovery.

Protein aggregation and neurodegeneration: clues from a yeast model of Huntington's disease

A number of neurodegenerative diseases are accompanied by the appearance of intracellular protein aggregates. Huntington's disease (HD) is caused by a mutation in a gene encoding huntingtin. The mutation causes the expansion of the polyglutamine (polyQ) domain and consequently polyQ-containing aggregates accumulate and neurons in the striatum die. The role of the aggregates is still not clear: they may be the cause of cytotoxicity or a manifestation of the cellular attempt to remove the misfolded proteins. There is accumulating evidence that the main cause of HD is the interaction of the mutated huntingtin with other polyQ-containing proteins and molecular chaperones and most studies based on a yeast model of HD support this point of view. Data obtained using yeasts suggest pathological consequences of polyQ-proteasomal interaction: proteasomal overload by polyQs may interfere with functions of the cell cycle-regulating proteins.