[Emergent treatment of a malignant peripheral epineurial tumour].
BACKGROUND
Malignant peripheral epineurial tumours are a group of tumours that derive histomorphologically from peripheral nerve sheaths. They occur sporadically, with an incidence of approximately 0.001%, and very rarely require emergency operation.
An athletic 19-year-old man presented to an orthopaedic outpatient clinic with lumboischialgia and weakness of the third and fourth left toes. A 12 x 10 x 8-cm paravertebral/retroperitoneal tumour was diagnosed by CT, and the patient was referred to our clinic. For classification, CT-assisted puncture of the tumour was carried out. A haemorrhage into the tumour resulted from the puncture, with consequently lower Hb level and progressive peripheral sensomotoric deficits demanding emergency surgery on a weekend. On this occasion, the tumour was resected together with the L5 and S1 nerve roots through cooperation between the general surgical and neurosurgical departments and was classified as a malignant peripheral epineurial tumour in the rapid stage. Due to the spinal R2 resection, after-loading probes were inserted and the tumour bed was clip-marked. Percutaneous radiotherapy and brachytherapy followed postoperatively. Shortly afterwards, relaparotomy had to be performed due to an adhesive ileus, from which the patient recovered quickly. Chemotherapy was carried out due to a G2 tumour classification. The patient is currently undergoing rehabilitation, during which the peripheral neurological deficits are improving gradually.


CONCLUSIONS
This rare case of a malignant peripheral epineurial tumour with acute symptoms demonstrates the ability of hospitals with maximum care facilities to maintain services even in times of financial cuts in health care services.
Schafmayer
C
C
Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel. cschafmayer@chirurgie-sh.de
Egberts
J-H
JH
Kovács
G
G
Leuschner
I
I
Tepel
J
J
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004630:Emergencies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D004317:Doxorubicin; D007069:Ifosfamide