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Malignant peripheral nerve sheath tumor of the sciatic nerve presenting with leg pain in the setting of lumbar scoliosis and spinal stenosis

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Abstract

Study design

Case report.

Objective

We present a case of malignant peripheral nerve sheath tumor (MPNST) presenting as neuropathic pain in the setting of lumbar scoliosis and spinal stenosis.

Summary of background data

Most peripheral nerve sheath tumors are benign, and malignant cases are more commonly associated with neurofibromatosis type 1 or prior radiation exposure. MPNST is a rare tumor with a poor prognosis. We report a case of MPNST that presented as neuropathic pain following lumbar decompression and fusion surgery.

Methods

A 60-year-old woman presented for management of lumbar scoliosis, stenosis, and left leg pain. After lumbar decompression and fusion surgery, the patient was readmitted to the hospital after falling 10 weeks post-op. She reported gradual recurrence of leg pain. Left foot drop was noted on exam. Imaging studies showed no spinal changes postoperatively or residual stenosis. Obesity limited electrodiagnostic studies. Hip MRI revealed a lobular soft tissue mass in the left sciatic notch. Surgical resection and pathology provided the diagnosis of MPNST. The patient declined wide resection and other interventions after seeking a second opinion. Palliative pain management was implemented.

Results

The patient expired 15 months after her index spinal surgery.

Conclusions

MPNST is an extremely rare tumor that can present with symptoms similar to radiculitis. Clinical signs and symptoms of MPNST are vague and nonspecific due to compression of surrounding structures. Surgical wide resection is the first line of treatment for MPNST with chemotherapy and radiotherapy as adjuvant treatments. MPNST has a poor prognosis with reported 5-year survival ranging from 16 to 54%. This case demonstrates the need to pursue additional workup when diagnostic imaging and objective findings do not satisfactorily explain the clinical presentation.

Level of evidence

IV

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References

  1. Thway K, Fisher C (2014) Malignant peripheral nerve sheath tumor: pathology and genetics. Ann Diagn Pathol 18(2):109–116. https://doi.org/10.1016/j.anndiagpath.2013.10.007

    Article  PubMed  Google Scholar 

  2. Winslow N, Abode-Iyamah K, Kirby P et al (2015) Malignant peripheral nerve sheath tumor arising in the setting of cervical nerve root schwannomas. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2015.05.016

    Article  PubMed  Google Scholar 

  3. Evans DGR, Baser ME, McGaughran J et al (2002) Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet 39:311–314. https://doi.org/10.1136/jmg.39.5.311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ducatman BS, Scheithauer BW (1983) Postirradiation neurofibrosarcoma. Cancer 51:1028–1033

    Article  CAS  Google Scholar 

  5. Foley KM, Woodruff JM, Ellis FT et al (1980) Radiation-induced malignant and atypical peripheral nerve sheath tumors. Ann Neuro 7:311–318. https://doi.org/10.1002/ana.410070405

    Article  CAS  Google Scholar 

  6. Cury J, Coelho RF, Srougi M (2007) Retroperitoneal schwannoma: case series and literature review. Clinics 62:359–362. https://doi.org/10.1590/s1807-59322007000300024

    Article  PubMed  Google Scholar 

  7. Tortorelli AP, Rosa F, Papa V et al (2007) Retroperitoneal schwannomas: diagnostic and therapeutic implications. Tumori 93:312–315

    Article  Google Scholar 

  8. Li Q, Gao C, Juzi JT et al (2007) Analysis of 82 cases of retroperitoneal schwannoma. ANZ J Surg 77:237–240. https://doi.org/10.1111/j.1445-2197.2007.04025.x

    Article  PubMed  Google Scholar 

  9. Hayasaka K, Tanaka Y, Soeda S et al (1999) MR findings in primary retroperitoneal schwannoma. Acta Radiol 40:78–82. https://doi.org/10.1080/02841859909174408

    Article  CAS  PubMed  Google Scholar 

  10. Tabesh H, Tabesh A, Fakharian E et al (2015) The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica. J Res Med Sci 20:150–153

    PubMed  PubMed Central  Google Scholar 

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Funding

Funding was provided by the Department of Orthopaedic Surgery at Syosset Hospital.

Author information

Authors and Affiliations

  1. Northwell Health, New York Orthopaedic and Spine Center, 833 Northern Boulevard, Suite 220, Great Neck, NY, 11021, USA

    Sanjeev J. Suratwala & Vincent Leone

  2. Syosset Hospital at Northwell Health, 221 Jericho Turnpike, Syosset, NY, 11791, USA

    MaryAnne Cronin & Vincent Leone

  3. Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Katelyn Kondra

Authors
  1. Sanjeev J. Suratwala
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  2. Katelyn Kondra
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  3. MaryAnne Cronin
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  4. Vincent Leone
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Contributions

SS: surgeon, analysis, interpretation, drafting, revising, and final approval of manuscript. MC: drafting, revising, and final approval of manuscript. KK: drafting, revising, and final approval of manuscript. VL: surgeon, analysis, interpretation, drafting, revising, and final approval of manuscript.

Corresponding author

Correspondence to Sanjeev J. Suratwala.

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Suratwala, S.J., Kondra, K., Cronin, M. et al. Malignant peripheral nerve sheath tumor of the sciatic nerve presenting with leg pain in the setting of lumbar scoliosis and spinal stenosis. Spine Deform 8, 333–338 (2020). https://doi.org/10.1007/s43390-019-00013-3

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  • DOI: https://doi.org/10.1007/s43390-019-00013-3

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