Perineurální šíření pánevních nádorů: mechanismus a diagnostika

• Název práce v češtině: Perineurální šíření pánevních nádorů: mechanismus a diagnostika
• Název v anglickém jazyce: Perineural spread of pelvic tumors: mechanism and diagnosis
• Klíčová slova: karcinom prostaty, karcinom děložního hrdla, karcinom močového měchýře, kolorektální karcinom, perineurální šíření, metastáza
• Klíčová slova anglicky: prostate cancer, cervical cancer, bladder cancer, rectal cancer, perineural spread, metastasis
• Akademický rok vypsání: 2013/2014
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Mimofakultní pracoviště (13-999)
• Vedoucí / školitel: prof. MUDr. Martin Sameš, CSc.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 07.01.2015
• Datum zadání: 07.01.2015
• Datum potvrzení stud. oddělením: 07.01.2015
• Datum a čas obhajoby: 20.09.2021 13:00
• Datum odevzdání elektronické podoby: 20.05.2021
• Datum odevzdání tištěné podoby: 21.05.2021
• Datum proběhlé obhajoby: 20.09.2021
• Oponenti: prof. MUDr. Pavel Haninec, CSc.

Seznam odborné literatury

1. Abouzahr MK, Lange DJ, Latov N, Olarte M, Rowland LP, Hays AP, et al. Diagnostic biopsy of the motor nerve to the gracilis muscle. J Neurosurg. 1997;87(1):122–4.
2. Agadi JB, Raghav G, Mahadevan A, Shankar SK. Usefulness of superficial peroneal nerve/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy. J Clin Neurosci Official J Neurosurg Soc Australas. 2012;19(10):1392–6.
3. Agarwal M, Wangaryattawanich P, Rath TJ. Perineural Tumor Spread in Head and Neck Malignancies. Semin Roentgenol. 2019;54(3):258–75.
4. Aghion DM, Capek S, Howe BM, Hepel JT, Sambandam S, Oyelese AA, et al. Perineural tumor spread of bladder cancer causing lumbosacral plexopathy: an anatomic explanation. Acta Neurochir. 2014;156(12):2331–6.
5. Amit M, Na’ara S, Binenbaum Y, Gil Z. Abstract 2355: Marrow-derived macrophages mediate invasion of pancreatic adenocarcinoma by RET activation. Tumor Biol. 2015;2355–2355.
6. Amit M, Na’ara S, Gil Z. Mechanisms of cancer dissemination along nerves. Nat Rev Cancer. 2016;16(6):399–408.
7. Amrami KK, Felmlee JP, Spinner RJ. MRI of Peripheral Nerves. Neurosurg Clin N Am. 2008;19(4):559–72.
8. Anaf V, Nakadi IE, Moor VD, Chapron C, Pistofidis G, Noel J-C. Increased nerve density in deep infiltrating endometriotic nodules. Gynecol Obstet Inves. 2010;71(2):112–7.
9. Anaf V, Simon P, Nakadi IE, Fayt I, Simonart T, Buxant F, et al. Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod. 2002;17(7):1895–900.
10. Asante A, Taylor RN. Endometriosis: The Role of Neuroangiogenesis. Annu Rev Physiol. 2011;73(1):163–82.
11. Ayala GE, Dai H, Ittmann M, Li R, Powell M, Frolov A, et al. Growth and Survival Mechanisms Associated with Perineural Invasion in Prostate Cancer. Cancer Res. 2004;64(17):6082–90.
12. Ayala GE, Dai H, Li R, Ittmann M, Thompson TC, Rowley D, et al. Bystin in perineural invasion of prostate cancer. Prostate. 2006a;66(3):266–72.
13. Ayala GE, Dai H, Tahir SA, Li R, Timme T, Ittmann M, et al. Stromal Antiapoptotic Paracrine Loop in Perineural Invasion of Prostatic Carcinoma. Cancer Res. 2006b;66(10):5159–64.
14. Ayala GE, Wheeler TM, Shine HD, Schmelz M, Frolov A, Chakraborty S, et al. In vitro dorsal root ganglia and human prostate cell line interaction: Redefining perineural invasion in prostate cancer. Prostate. 2001;49(3):213–23.
15. Baader B, Herrmann M. Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat. 2003;16(2):119–30.
16. Badib AO, Kurohara SS, Webster JH, Pickren JW. Metastasis to organs in carcinoma of the uterine cervix: Influence of treatment on incidence and distribution. Cancer. 1968;21(3):434–9.
17. Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro-oncology. 2003;5(2):104–15.
18. Bakst RL, Glastonbury CM, Parvathaneni U, Katabi N, Hu KS, Yom SS. Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer: A Critical Review. Int J Radiat Oncol Biology Phys. 2018;103(5):1109–24.
19. Barrett AW, Speight PM. Perineural invasion in adenoid cystic carcinoma of the salivary glands: A valid prognostic indicator? Oral Oncol. 2009;45(11):936–40.
20. Bartels AL, Zeebregts CJ, Enting RH, Slart RH. Fluorodeoxyglucose and C-Choline positron emission tomography for distinction of metastatic plexopathy and neuritis: a case report. Cases J. 2009;2(1):9323.
21. Batsakis JG. Nerves and neurotropic carcinomas. Ann Otology Rhinology Laryngology. 1985;94(4 Pt 1):426–7.
22. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940;112(1):138–49.
23. Beets-Tan RGH, Beets GL, Borstlap ACW, Oei TK, Teune TM, Meyenfeldt MF von, et al. Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI? Abdom Imaging. 2000;25(5):533–41.
24. Boyle KM, Sagar PM, Chalmers AG, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for Locally Recurrent Rectal Cancer. Dis Colon Rectum. 2005;48(5):929–37.
25. Capek S, Amrami KK, Dyck PJB, Spinner RJ. Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique. Neurosurg Focus. 2015a;39(3):E12.
26. Capek S, Amrami KK, Howe BM, Collins MS, Sandroni P, Cheville JC, et al. Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica. Acta Neurochir. 2016;158(3):507–12; discussion 512.
27. Capek S, Hébert-Blouin M-N, Puffer RC, Martinoli C, Frick MA, Amrami KK, et al. Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association. Skeletal Radiol. 2015b;44(7):1001–9.
28. Capek S, Howe BM, Amrami KK, Spinner RJ. Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus. 2015c;39(3):E14.
29. Capek S, Howe BM, Froemming AT, Amrami KK, Spinner RJ. Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread. A report of two cases. Skeletal Radiol. 2015d;44(9):1365– 70.
30. Capek S, Howe BM, Tracy JA, García JJ, Amrami KK, Spinner RJ. Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report. J Neurosurg. 2015e;122(4):778–83.
31. Capek S, Sullivan PS, Howe BM, Smyrk TC, Amrami KK, Spinner RJ, et al. Recurrent rectal cancer causing lumbosacral plexopathy with perineural spread to the spinal nerves and the sciatic nerve: An anatomic explanation: Perineural Spread in Rectal Cancer. Clin Anat. 2014;28(1):136–43.
32. Ceyhan GO, Bergmann F, Kadihasanoglu M, Altintas B, Demir IE, Hinz U, et al. Pancreatic Neuropathy and Neuropathic Pain—A Comprehensive Pathomorphological Study of 546 Cases. Gastroenterology. 2009;136(1):177-186.e1.
33. Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18(1):157–61.
34. Chapron C, Santulli P, Ziegler D de, Noel J-C, Anaf V, Streuli I, et al. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod. 2012;27(3):702–11.
35. Chen S-H, Zhang B-Y, Zhou B, Zhu C-Z, Sun L-Q, Feng Y-J. Perineural invasion of cancer: a complex crosstalk between cells and molecules in the perineural niche. Am J Cancer Res. 2019;9(1):1–21.
36. Cho D-Y, Wang Y-C, Chen J-T. Intradural Metastasis to the Cauda Equina From Carcinoma of the Anus. Spine. 1995;20(21):2341–4.
37. Cui L, Shi Y, Zhang GN. Perineural invasion as a prognostic factor for cervical cancer: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015;292(1):13– 9.
38. Dalmau J, Graus F, Marco M. “Hot and dry foot” as initial manifestation of neoplastic lumbosacral plexopathy. Neurology. 1989;39(6):871–871.
39. DeGrado TR, Coleman RE, Wang S, Baldwin SW, Orr MD, Robertson CN, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res. 2001;61(1):110– 7.
40. Dieguez A. Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging. Cancer Imaging. 2013;13(2):277–97.
41. Donat SM, Genega EM, Herr HW, Reuter VE. Mechanisms of prostatic stromal invasion in patients with bladder cancer: clinical significance. J Urology. 2001;165(4):1117–20.
42. Dyck PJ, Lofgren EP. Method of fascicular biopsy of human peripheral nerve for electrophysiologic and histologic study. Mayo Clin Proc. 1966;41(11):778–84.
43. Evans R, Watson CPN. The Hot Foot Syndrome: Evans’ Sign and the Old Way. Pain Res Management. 2012;17(1):31–4.
44. Fowler BZ, Crocker IR, Johnstone PAS. Perineural spread of cutaneous malignancy to the brain. Cancer. 2005;103(10):2143–53.
45. Gaeta M, Pandolfo I, Russi E, Blandino A, Volta S, Racchiusa S. Pelvic Carcinomatous Neuropathy. J Comput Assist Tomo. 1988;12(5):811–6.
46. Gan HK, Azad A, Cher L, Mitchell PLR. Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab. Neuro-oncology. 2010;12(2):212–5.
47. Gierada DS, Erickson SJ. MR imaging of the sacral plexus: abnormal findings. Am J Roentgenol. 1993;160(5):1067–71.
48. Howe BM, Amrami KK, Nathan MA, Garcia JJ, Spinner RJ. Perineural spread of cervical cancer to the sciatic nerve. Skeletal Radiol. 2013;42(11):1627–31.
49. Huh JW, Kim HR, Kim YJ. Lymphovascular or Perineural Invasion May Predict Lymph Node Metastasis in Patients With T1 and T2 Colorectal Cancer. J Gastrointest Surg. 2010;14(7):1074–80.
50. Inman VT, Saunders JM. Referred pain from skeletal structures. J Nerv Ment Dis. 1944;99(5):660–7.
51. Jacobs JJ, Capek S, Spinner RJ, Swanson KR. Mathematical model of perineural tumor spread: a pilot study. Acta Neurochir. 2017;160(3):655–61.
52. Jaeckle KA. Lumbosacral plexopathy in cancer patients. Neurology. 1985;35(9):1393– 1393.
53. Jaeckle KA. Neurological manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. 2004;24(4):385–93.
54. Jansson KH, Castillo DG, Morris JW, Boggs ME, Czymmek KJ, Adams EL, et al. Identification of beta-2 as a key cell adhesion molecule in PCa cell neurotropic behavior: a novel ex vivo and biophysical approach. Plos One. 2014;9(6):e98408.
55. Johnson RE, Pomeroy TC. Evaluation of therapeutic results in Ewing’s sarcoma. Am J Roentgenol. 1975;123(3):583–7.
56. Kalfas F, Scudieri C. Intramedullary metastasis to the cervical spinal cord from malignant pleural mesothelioma: Review of the literature and case reports. Asian J Neurosurg. 2020;15(1):70.
57. Kanda T. Biology of the blood-nerve barrier and its alteration in immune mediated neuropathies. J Neurology Neurosurg Psychiatry. 2012;84(2):208–12.
58. Kayahara M, Nakagawara H, Kitagawa H, Ohta T. The Nature of Neural Invasion by Pancreatic Cancer. Pancreas. 2007;35(3):218–23.
59. Kurtz KA, Hoffman HT, Zimmerman MB, Robinson RA. Perineural and Vascular Invasion in Oral Cavity Squamous Carcinoma: Increased Incidence on Re-review of Slides and by Using Immunohistochemical Enhancement. Arch Pathol Lab Med. 2005;129(3):354–9.
60. LaBan MM, Meerschaert JR, Taylor RS. Electromyographic evidence of inferior gluteal nerve compromise: an early representation of recurrent colorectal carcinoma. Arch Phys Med Rehab. 1982;63(1):33–5.
61. Ladha SS, Spinner RJ, Suarez GA, Amrami KK, Dyck PJB. Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: An unusual entity. Muscle Nerve. 2006;34(5):659–65.
62. Leissner J, Koeppen C, Wolf HK. Prognostic Significance of Vascular and Perineural Invasion in Urothelial Bladder Cancer Treated With Radical Cystectomy. J Urology. 2003;169(3):955–60.
63. Li R, Wheeler T, Dai H, Ayala G. Neural cell adhesion molecule is upregulated in nerves with prostate cancer invasion. Hum Pathol. 2003;34(5):457–61.
64. Liebig C, Ayala G, Wilks JA, Berger DH, Albo D. Perineural invasion in cancer: A Review of the Literature. Cancer. 2009;115(15):3379–91.
65. Liebl F, Demir IE, Rosenberg R, Boldis A, Yildiz E, Kujundzic K, et al. The Severity of Neural Invasion Is Associated with Shortened Survival in Colon Cancer. Clin Cancer Res. 2012;19(1):50–61.
66. Mahadevia PS, Koss LG, Tar IJ. Prostatic involvement in bladder cancer: Prostate mapping in 20 cystoprostatectomy specimens. Cancer. 1986;58(9):2096–102.
67. Maru N, Ohori M, Kattan MW, Scardino PT, Wheeler TM. Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens. Hum Pathol. 2001;32(8):828–33.
68. Mauermann ML, Amrami KK, Kuntz NL, Spinner RJ, Dyck PJ, Bosch EP, et al. Longitudinal study of intraneural perineurioma--a benign, focal hypertrophic neuropathy of youth. Brain J Neurology. 2009;132(Pt 8):2265–76.
69. Moalem G, Monsonego A, Shani Y, Cohen IR, Schwartz M. Differential T cell response in central and peripheral nerve injury: connection with immune privilege. Faseb J. 1999;13(10):1207–17.
70. Moonis G, Cunnane MB, Emerick K, Curtin H. Patterns of Perineural Tumor Spread in Head and Neck Cancer. Magn Reson Imaging C. 2012;20(3):435–46.
71. Murthy NK, Amrami KK, Spinner RJ. Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies. Acta Neurochir. 2020;162(12):3179–87.
72. Neal ML, Trister AD, Ahn S, Baldock A, Bridge CA, Guyman L, et al. Response Classification Based on a Minimal Model of Glioblastoma Growth Is Prognostic for Clinical Outcomes and Distinguishes Progression from Pseudoprogression. Cancer Res. 2013a;73(10):2976–86.
73. Neal ML, Trister AD, Cloke T, Sodt R, Ahn S, Baldock AL, et al. Discriminating Survival Outcomes in Patients with Glioblastoma Using a Simulation-Based, Patient- Specific Response Metric. Plos One. 2013b;8(1):e51951.
74. Oberlin C, Durand S, Belheyar Z, Shafi M, David E, Asfazadourian H. Nerve transfers in brachial plexus palsies. Chir Main. 2008;28(1):1–9.
75. Oh SJ. Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J. 1990;31(1):1.
76. Orphanos G, Ioannidis G, Michael M, Kitrou G. Prostate-specific antigen in the cerebrospinal fluid: a marker of local disease. Medical Oncol Northwood Lond Engl. 2008;26(2):143–6.
77. Orte C, Lawrenson JG, Finn TM, Reid AR, Allt G. A comparison of blood-brain barrier and blood-nerve barrier endothelial cell markers. Anat Embryol. 1999;199(6):509–17.
78. Ozaki H, Hiraoka T, Mizumoto R, Matsuno S, Matsumoto Y, Nakayama T, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today. 1999;29(1):16–22.
79. Pantel K, Brakenhoff RH. Dissecting the metastatic cascade. Nat Rev Cancer. 2004;4(6):448–56.
80. Possover M, Chiantera V. Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril. 2007;87(2):417.e17-417.e19.
81. Possover M, Tersiev P, Angelov DN. Comparative study of the neuropeptide-Y sympathetic nerves in endometriotic involved and noninvolved sacrouterine ligaments in women with pelvic endometriosis. J Minim Invas Gyn L. 2009;16(3):340–3.
82. Puffer RC, Marek T, Stone JJ, Raghunathan A, Howe BM, Spinner RJ. Extensive perineural spread of an intrapelvic sciatic malignant peripheral nerve sheath tumor: a case report. Acta Neurochir. 2018;160(9):1833–6.
83. Restrepo CE, Spinner RJ, Howe BM, Jentoft ME, Markovic SN, Lachance DH. Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report. J Neurosurg. 2015;122(4):784–90.
84. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52(7):1317–29.
85. Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol. 2010;11(3):292–301.
86. Rodin AE, Larson DL, Roberts DK. Nature of the perineural space invaded by prostatic carcinoma. Cancer. 1967;20(10):1772–9.
87. Ruth A, Schulmeyer FJ, Roesch M, Woertgen C, Brawanski A. Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy. Clin Neurol Neurosur. 2005;107(3):214–7.
88. Saclarides TJ, Bhattacharyya AK, BrittonKuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum. 1994;37(1):52– 7.
89. Schaller B, Merlo A, Kirsch E, Lehmann K, Huber P, Lyrer P, et al. Prostate-specific antigen in the cerebrospinal fluid leads to diagnosis of solitary cauda equina metastasis: a unique case report and review of the literature. Brit J Cancer. 1998;77(12):2386–9.
90. Shoja MM, Sharma A, Mirzayan N, Groat C, Watanabe K, Loukas M, et al. Neuroanatomy of the female abdominopelvic region: A review with application to pelvic pain syndromes. Clin Anat. 2012;26(1):66–76.
91. Slavin ML, Abramson AL. Squamous cell carcinoma of the pterygopalatine fossa (retroantral space). J Clin Neuro-ophthal. 1986;6(4):254–7.
92. Sousa ACS de, Capek S, Howe BM, Jentoft ME, Amrami KK, Spinner RJ. Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurg Focus. 2015a;39(3):E15.
93. Sousa ACSD, Capek S, Amrami KK, Spinner RJ. Neural involvement in endometriosis: Review of anatomic distribution and mechanisms. Clin Anat. 2015b;28(8):1029–38.
94. Stone NN, Stock RG, Parikh D, Yeghiayan P, Unger P. Perineural invasion and seminal vesicle involvement predict pelvic lymph node metastasis in men with localized carcinoma of the prostate. J Urology. 1998;160(5):1722–6.
95. Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H. Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol. 1997;65(3):164–70.
96. Taylor BV, Kimmel DW, Krecke KN, Cascino TL. Magnetic Resonance Imaging in Cancer-Related Lumbosacral Plexopathy. Mayo Clin Proc. 1997;72(9):823–9.
97. Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology. 1985;35(1):1–1.
98. Uchida K, Kobayashi S, Yayama T, Muramatsu J, Kurokawa T, Imamura Y, et al. Metastatic involvement of sacral nerve roots from uterine carcinoma: a case report. Spine J. 2008;8(5):849–52.
99. Villers A, McNeal JE, Redwine EA, Freiha FS, Stamey TA. The Role of Perineural Space Invasion in the Local Spread of Prostatic Adenocarcinoma. J Urology. 1989;142(3):763–8.
100. Vonlaufen A, Joshi S, Qu C, Phillips PA, Xu Z, Parker NR, et al. Pancreatic Stellate Cells: Partners in Crime with Pancreatic Cancer Cells. Cancer Res. 2008;68(7):2085– 93.
101. Warren S, Harris P, Graves R. Osseous metastasis of carcinoma of the prostate with special reference to the perineural lymphatics. Arch Pathol. 1936 Jan 1;22(2):139–60.
102. Yang Y, Huang X, Sun J, Gao P, Song Y, Chen X, et al. Prognostic value of perineural invasion in colorectal cancer: a meta-analysis. J Gastrointest Surg Official J Soc Surg Alimentary Tract. 2015;19(6):1113–22.
103. Zahalka AH, Frenette PS. Nerves in cancer. Nat Rev Cancer. 2020;20(3):143–57.

Předběžná náplň práce

Nádorová onemocnění plexus lumbosacralis jsou relativně vzácná a v případech s minimálním nebo neurčitým nálezem na zobrazovacích metodách může být stanovení správné diagnózy velmi zdlouhavé. V této práci popisujeme skupinu pacientů s perineurálním šířením nádoru pánevních orgánů od primárního ložiska podél autonomních nervů do plexus lumbosacralis a dále proximálně do spinálních nervů či intradurálně nebo naopak distálně do n. ischiadicus. Na souboru 17 pacientů s diagnózou perineurálního šíření nádorů pánevních orgánů popisujeme charakteristickou anamnézu, fyzikální nález a nález na zobrazovacích metodách. Diagnostika se v těchto případech opírá o nález na zobrazovacích metodách a výsledek biopsie plexus lumbosacralis nebo n. ischiadicus. Tato práce popisuje operační techniku cílené fascikulární biopsie n. ischiadicus a na souboru 117 pacientů s biopsií n. ischiadicus úspěšnost, výsledky a komplikace. Diagnostická výtěžnost byla 84.8 % a frekvence komplikací byla 2.7 %. Pokud je ke stanovení diagnózy nezbytný vzorek tkáně, cílené biopsie periferních nervů vedou k vyšší diagnostické výtěžnosti s přiměřeným rizikem komplikací. Perineurální šíření pánevních nádorů je nová klinicko-patologická jednotka, o které zatím nemáme dostatek informací o prognóze a vhodné léčbě. Na základě výsledku zobrazovacích metod u pacientů s perineurální šířením pánevních orgánů představujeme první matematický model perineurálního šíření. Věříme, že naše práce povede k urychlení správné diagnózy, jelikož riziko stanovení špatné diagnózy je vysoké a vede k nenávratnému poškození.

Předběžná náplň práce v anglickém jazyce

Neoplastic lumbosacral plexopathies are infrequent affections of the lumbosacral plexus. Cases with minimal or non-specific finding on imaging can be particularly puzzling to diagnose. We describe a series of patients with perineural spread from the site of the primary tumor along the visceral autonomous nerves to the lumbosacral plexus and further proximally to the spinal nerves and even intradurally and also distally to the sciatic nerve. On series of 17 patients diagnosed with perineural spread of pelvic malignancy we describe characteristic clinical presentation and imaging finding. In many of these cases a tissue biopsy is necessary to finalize the diagnosis. We describe operative technique of targeted fascicular biopsy of the sciatic nerve and our experience with this procedure. On series of 117 patients, we report the outcome and complication: diagnostic yield was 84.8% and complication rate was 2.7 %. If a tissue sample is needed to conclude the diagnosis, targeted fascicular biopsy does increase the yield at an acceptable complication rate. Perineural spread of pelvic cancer is a new clinical-pathological entity with an unknown natural history or ideal treatment strategy. Based on the imaging finding in this group we present a first mathematical model of perineural spread. We believe that our experience will lead to improved diagnosis of similar patients as the risk of misdiagnosis is high and leads to irreversible damage.