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Clinical Case Reports, Int’l Journal of
2014, Vol.4, No.1, 1-4
http://ijccr.sophiapublisher.com
Case Report
Open Access
A Case Report of Malignant Peripheral Nerve Sheath Tumour (Mpnst) Which
Present as an Acute Traumatic Sciatic Neuropathy
Wong K.B. , Chan S.A.
Neurosurgical Department, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN
Corresponding Author email: kianboon_w@yahoo.com;
Author
International Journal of Clinical Case Reports, 2014, Vol.4, No.1 doi: 10.5376/ijccr.2014.04.0001
Copyright
© 2014 Wong et al. This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Malignant peripheral nerve sheath tumour (MPNST) is a very rare sarcoma and it accounts for around 5% of all sarcoma.
We are reporting an interesting case of sporadic MPNST at the proximal sciatic nerve which concealed as a traumatic cause of sciatic
neuropathy and foot drop. A 59 year old Caucasian lady presented with a constant paraesthesia and pain at her left hip after she had a
fall. On examination, there was marked neurological impairment along the L4, L5 and S1 distribution. A MRI of the pelvis was
performed. It revealed a large soft tissue mass at the centre of the left buttock arising from the proximal sciatica nerve. The biopsy
result revealed the diagnosis of malignant peripheral nerve sheath tumour (MPNST). She underwent a complete resection of tumour
with clear margins of the tumour. A vigilance MRI examination was performed 5 months post-operatively and no evidence
suggesting of local recurrences. However, 10 months after the operation a surveillance CT scan was performed and it revealed
presence of pulmonary metastases. MPNST is a heterogenous group of tumour arising from the Schwann cells or the perineural cells.
The presentation is usually subtle and invariably leads to a late diagnosis of the disease. The prognosis is often poor. The mainstay of
treatment is surgical resection. However, despite complete resection, the tumour can recur and metastasis. A continuous paraesthesia
and pain along nerve root must raise the suspicion among clinicians about the possibility of extraspinal causes of sciatica.
Keywords
MPNST; Malignant peripheral nerve sheath tumour; Sciatica; Foot drop
Introduction
Malignant Peripheral Nerve Sheath Tumour (MPNST)
is an extremely rare medical condition (Karr et al.,
2006; Nthumba and Juma, 2011). It is often
underappreciated as a cause of peripheral nerve
compression, especially the involvement of sciatic
nerve where spinal pathology and traumatic sciatic
neuropathy supersede the diagnosis. In the current
published literatures, the first presentation of MPNST
is usually a mass which follows nerve symptoms such
as pain, paraesthesia and limb weakness (Nthumba
and Juma, 2011). However, we are reporting an
interesting case of MPNST at the proximal sciatic
nerve which concealed as a traumatic cause of sciatic
neuropathy and foot drop, where a subtle mass was
only detected later.
1 Case
A 59 year old lady who was otherwise fit and healthy
presented with a 15 months history of left leg
weakness and pain. Initially she had a fall which
landed herself on her left hip while walking in the
snow. Ever since then, she has been complaining of a
constant dull pain around her left buttock. Hip trauma
was initially suspected and a hip x-ray was performed.
However, it did not show any bony fractures. The pain
gradually improved and it was diagnosed as an acute
traumatic neuropathic pain secondary to the fall.
However, she fell on her left hip again 15 months later.
Subsequently she started having severe pain in the left
buttock which radiated to the lower half of her left leg.
Hip x-ray was performed again and did not show any
fractures. She was therefore referred to the neurosurgical
Preferred citation for this article:
Wong and Chan, 2014, A Case Report of Malignant Peripheral Nerve Sheath Tumour (Mpnst) Which Present as an Acute Traumatic Sciatic Neuropathy,
International Journal of Clinical Case Reports, Vol.4, No.1 1-4 (doi: 10.5376/ijccr.2014.04.0001)
Received: 17 Dec., 2013
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Accepted: 02 Jan., 2014
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Published: 08 Feb., 2014
Clinical Case Reports, Int’l Journal of