A Case Report of Malignant Peripheral Nerve Sheath Tumour (Mpnst) Which Present as An Acute Traumatic Sciatic Neuropathy

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.