Metastatic involvement of sacral nerve roots from uterine carcinoma: a case report

Background contextMetastatic involvement of peripheral nerves is considered common in carcinoma of the head and neck with perineural invasion. It is also possible that perineural and endoneural invasion occur in presacral local recurrence. Little is reported about metastasis in pelvic lesions including sacral nerve roots.PurposeWe describe the clinical presentation and diagnosis of metastatic involvement of sacral nerve roots retrogradely from uterine carcinoma, and its implication for spine surgeons, along with a brief review of literature.Study design/settingA case report of a patient with metastatic lesions in S1 and S2 nerve roots originating from uterine adenocarcinoma is presented.MethodsA 39-year-old woman with history of uterine cancer presented with persistent severe low back pain, intractable radicular pain, and neurological deficit in the right lower extremity. She had undergone radical hysterectomy for uterine adenocarcinoma 4 years ago followed by chemotherapy and radiotherapy. Magnetic resonance imaging (MRI) revealed abnormal swelling of the S1 and S2 nerve roots along with a soft-tissue mass in the retroperitoneal space.ResultsThe patient underwent surgical rhizotomy and histology of the roots revealed metastatic tumor in the dorsal root ganglion. The patient had good pain relief, she died of metastatic disease 3 years later.ConclusionsDespite being uncommon, sacral nerve root metastasis should be considered in some patients with history of cancer of pelvic organs including the uterus. MR images were of little value in differentiating a carcinomatous lesion from a benign lesion.