Top

Published in:

01-04-2009 | Neuro-Oncology

Neurogenic Tumors of the Pelvis: Clinicopathologic Features and Surgical Outcomes Using a Multidisciplinary Team

Authors: Eric J. Dozois, MD, Jarrod C. H. Wall, MD, Robert J. Spinner, MD, David J. Jacofsky, MD, Michael J. Yaszemski, MD, PhD, Franklin H. Sim, MD, Steven L. Moran, MD, Robert R. Cima, MD, Dirk R. Larson, Michael G. Haddock, MD, Scott H. Okuno, MD, David W. Larson, MD

Published in: Annals of Surgical Oncology | Issue 4/2009

Abstract

Background

Few data exist regarding the outcomes in patients undergoing surgery for pelvic tumors of neurogenic origin. Our aim was to characterize the clinical and pathologic features of pelvic neurogenic tumors and assess surgical outcomes.

Methods

All patients who underwent operations for pelvic neurogenic tumors at our institution between 1956 and 2004 were identified. Data analyzed included demographics, clinical features, histopathology, local recurrence, and survival.

Results

Eighty-nine patients were identified, of whom 44 were male. Median age was 38 years. The most common presenting symptom was low back or pelvic pain (56%). Malignant lesions were found in 43 patients (48%). Schwannomas were the most common benign tumor (61%) and malignant peripheral nerve sheath tumors the most common malignant lesion (81%). Median tumor size was 9.5 cm (range 0.8–32 cm). Malignant tumors had histopathologic evidence of infiltration of surrounding structures in 49% of cases. Intralesional resection was the most common surgical technique for both benign and malignant tumors. Thirty-day mortality was nil; major morbidity was seen in 13%. Adjuvant therapy was given to 91% of the patients with malignant disease. Five-year local recurrence rates for benign and malignant lesions were 35.9% and 35.0%, respectively. Distant recurrence for malignant lesions was 65.1% at 5 years. Five-year disease-free survival for malignant tumors was 25.9%.

Conclusion

Pelvic neurogenic tumors occurring in young patients may be large when detected and present with nonspecific symptoms. Benign and malignant tumors had a high local recurrence rate and survival for malignant tumors was poor. Early detection and aggressive surgical intervention should improve outcome.

Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors. Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28:644–52.

Cody, HS, Marcove Rc, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Caner Center. Dis Colon Rectum. 1981;24:501–6.PubMedCrossRef

Dafford K, Kim D, Ried N, Kline D. Pelvic plexus tumors. Neurosurg Focus. 2007;22(6):1–5.

Kim DH, Murovic JA, Tiel RL, Kline DG. Operative outcomes of 546 Louisiana State University Health Sciences Center peripheral nerve tumors. Neurosurg Clin North Am. 2004;15:177–92.CrossRef

Konstantinidis K, Theodoropolous GE, Sambalis G, Georgiou M, Vorias M, Anastassakou K, et al. Laparoscopic resection of presacral schwannomas. Surg Laparosc Percutan Tech. 2005;15(5):302–4.CrossRef

Borghese M, Corigliano N, Gabriele R, Antoniozzi A, Izzo L, Barbaro M, et al. Benign schwannoma of the pelvic retroperitoneum. Report of a case and review of the literature. G Chir. 2000;21:232–8.PubMed

Shoher A, Arbab F, Lucci A. Giant pelvic schwannoma with ancient change. JACS. 2003;197:163.CrossRef

Abernathey CD, Onofrio BM, Scheithauer B, Pairolero PC, Shives TC. Surgical management of giant sacral schwannomas. J Neurosurg. 1986;65:286–95.PubMedCrossRef

Stull MA, Moser RP Jr, Kransdorf MJ, Bogumill GP, Nelson MC. Magnetic resonance appearance of peripheral nerve sheath tumors. Skeletal Radiol. 1991;20:9–14.PubMedCrossRef

10.

Varma DG, Moulopoulos A, Sara AS, Leeds N, Kumar R, Kim EE, et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr. 1991;16:448–53.CrossRef

11.

Solomon SB, Semih Dogan A, Nicol TL, Campbell JN, Pomper MG. Positron emission tomography in the detection and management of sarcomatous transformation in neurofibromatosis. Clin Nucl Med. 2001;26:525–8.PubMedCrossRef

12.

Blum MD, Bahnson RR, Carter MF. Urologic manifestations of von Recklinghausen neurofibromatosis. Urology. 1985;26:209–17.PubMedCrossRef

13.

Topsakal C, Erol FS, Ozercan I, Murat A, Gurates B. Presacral solitary giant neurofibroma without neurofibromatosis type 1 presenting as pelvic mass-case report. Neurol Med Chir. 2001;41:620–5.CrossRef

14.

Kretschmer T, Antoniadis G, Heinen C, Börm W, Scheller C, Richter HP, et al. Nerve sheath tumor surgery: case-guided discussion of ambiguous findings, appropriateness of removal, repeated surgery, and nerve repairs. Neurosurg Focus. 2007;22(6)E19:1–9.

15.

Gachiani J, Kim D, Nelson A, Kline D. Surgical management of malignant peripheral nerve sheath tumors. Neurosurg Focus. 2007;22(6)E13:1–8.

16.

Lev-Chelouche D, Gutman M, Goldman G, Even-Sapir E, Meller I, Issakov J, et al. Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery. 2003;133:473–8.PubMedCrossRef

17.

Luken MG 3^rd, Michelsen WJ, Whelan MA, Andrews DL. The diagnosis of sacral lesions. Surg Neurol. 1981;15:377–83.PubMedCrossRef

18.

Bohm B, Milsom JW, Fazio VW, Lavery IC, Church JM, Oakley JR. Our approach to the management of congenital presacral tumors in adults. Int J Colorectal Dis. 1993;8:134–8.PubMedCrossRef

19.

Donner TR, Voorhies RM, Kline DG. Neural sheath tumors of major nerves. J Neurosurg. 1994;81:362–73.PubMed

20.

Ganju A, Roosen N, Kline DG, Tiel RL. Outcomes in consecutive series of 111 surgically treated plexal tumors: a review of the experience at Louisiana State University Health Sciences Center. J Neurosurg. 2001;95:51–60.PubMed

21.

Ryu S, Tiel RL, Kline DG. Surgical management and results of 135 tibial nerve lesions at the Louisiana State University Health Science Center. Neurosurgery. 2003;53:1114–1125.PubMed

22.

Melvin WS. Laparoscopic resection of a pelvic schwannoma. Surg Laparosc Endosc. 1996;6:489–91.PubMedCrossRef

23.

Nishi H, Kido T, Yamanishi H, Nakahara M, Nakao K, Tsujimoto M. Endoscopic resection of a pelvic neurogenic tumor through the retroperitoneal approach. Surg Endosc. 2000;14:767.PubMed

24.

Nishi A, Adachi W, Iragashi J, Koide N, Kajikawa S, Amano J. Laparoscopic resection of a retroperitoneal schwannoma. Surg Laparosc Endosc Percutan Tech. 1999;9:306–9.CrossRef

25.

Baehring JM, Betensky RA, Batchelor TT. Malignant peripheral nerve sheath tumor: the clinical spectrum and outcome of treatment. Neurology. 2003;61:696–8.PubMed

26.

Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathological study of 120 cases. Cancer. 1986;57:2006–21.PubMedCrossRef

27.

Yang J, Chang A, Baker A, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.PubMed

28.

Angelov L, Davis A, O’Sullivan B, Bell R, Guha A. Neurogenic sarcomas: experience at the University of Toronto. Neurosurgery. 1998;43:56–64.PubMedCrossRef

29.

Rosenberg S, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities. Ann Surg. 1982;196(3):305–15.PubMedCrossRef

30.

Tierney J, Stewart L, Parmar M, et al. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adult: meta-analysis of individual data. Lancet. 1997;350:1647–54.CrossRef

31.

Casanova M, Ferrari A, Spreafico F, Luksch R, Terenziani M, Cefalo G, et al. Malignant peripheral nerve sheath tumors in children: a singe-institution twenty-year experience. J Pediatr Hematol Oncol. 1999;21:509–13.PubMedCrossRef

32.

Kar M, Deo SS, Shukla NK, Malik A, DattaGupta S, Mohanti BK, et al. Malignant peripheral nerve sheath tumors (MPNST) – Clinicopathological study and treatment outcome of 24 cases. World J Surg Oncol. 2006;4:55.PubMedCrossRef

33.

Raut CP. Pisters PW. Retroperitoneal sarcomas: Combined-modality treatment approaches. J Surg Oncol. 2006;94(1):81–7.PubMedCrossRef

Title: Neurogenic Tumors of the Pelvis: Clinicopathologic Features and Surgical Outcomes Using a Multidisciplinary Team
Authors: Eric J. Dozois, MD
Jarrod C. H. Wall, MD
Robert J. Spinner, MD
David J. Jacofsky, MD
Michael J. Yaszemski, MD, PhD
Franklin H. Sim, MD
Steven L. Moran, MD
Robert R. Cima, MD
Dirk R. Larson
Michael G. Haddock, MD
Scott H. Okuno, MD
David W. Larson, MD
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0344-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neurogenic Tumors of the Pelvis: Clinicopathologic Features and Surgical Outcomes Using a Multidisciplinary Team

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2009

Gastroesophageal Cancer Research, Study Design, and Continuing Dialogue

A Career in Surgical Oncology: Not Finding Meaning, Balance, and Personal Satisfaction

Genome-Wide Association Studies and Aggressive Surgery Toward Individualized Prevention, and Improved Local Control and Overall Survival for Gastric Cancer

Lymph Node Yield as a Prognostic Factor in Cancer Studies—Due to Undersampling of Tumor-Free Lymph Nodes at Higher N Stages?

Differentiating Early and Late Recurrences After Resection of HCC in Cirrhotic Patients: Implications on Surveillance, Prevention, and Treatment Strategies

Analysis of the Extent of Resection for Adenocarcinoma of the Gallbladder