title: Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report.
abstract: Perineural tumor spread in prostate cancer is emerging as a mechanism to explain select cases of neurological dysfunction and as a cause of morbidity and tumor recurrence. Perineural spread has been shown to extend from the prostate bed to the lumbosacral plexus and then distally to the sciatic nerve or proximally to the sacral and lumbar nerves and even intradurally. The authors present a case of a bilateral neoplastic lumbosacral plexopathy that can be explained anatomically as an extension of the same process: from one lumbosacral plexus to the contralateral one utilizing the dural sac as a bridge between the opposite sacral nerve roots. Their theory is supported by sequential progression of symptoms and findings on clinical examinations as well as high-resolution imaging (MRI and PET/CT scans). The neoplastic nature of the process was confirmed by a sciatic nerve fascicular biopsy. The authors believe that transmedian dural spread allows continuity of a neoplastic process from one side of the body to the other.
authors: Departments of 1 Neurosurgery.
authors: Stepan
authors: S
authors: Capek
authors: Benjamin M
authors: BM
authors: Howe
authors: Jennifer A
authors: JA
authors: Tracy
authors: Joaquín J
authors: JJ
authors: García
authors: Kimberly K
authors: KK
authors: Amrami
authors: Robert J
authors: RJ
authors: Spinner
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D006801:Humans; D008160:Lumbosacral Plexus / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011182:Postoperative Care; D011471:Prostatic Neoplasms / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery
keywords: CSF = cerebrospinal fluid; EMG = electromyography; FDG = fluorodeoxyglucose; PET/CT = positron-emission tomography/computed tomography; PNI = perineural invasion; PSA = prostate-specific antigen; bilateral; lumbosacral plexopathy; oncology; perineural spread; plexopathy; prostate cancer