Brachial plexopathy and intradural cord compression caused by malignant peripheral nerve sheath tumor a case report and literature review

Introduction and importance

Diagnosing brachial plexopathy in cancer patients who have undergone treatment and are being monitored presents a significant difficulty due to the potential involvement of multiple factors, including tumor recurrence causing compression or infiltration, recurrent metastasis, or the effects of radiation therapy. Malignant peripheral nerve sheath tumors (MPNSTs) have the potential to impact the brachial plexus, resulting in brachial plexopathy. Misdiagnosis can lead to catastrophic outcomes.

Case presentation

A 29-year-old female patient, who had a previous history of nasopharyngeal carcinoma, exhibited symptoms consistent with brachial plexopathy. The primary diagnoses for the cause were tumor metastatic recurrence and radiation-induced brachial plexopathy. Following an evaluation, recurrence appeared to be the most probable diagnosis. The mass had infiltrated along the brachial plexus, resulting in an intradural mass that led to cord compression. The final pathology report confirmed that the original pathology was malignant peripheral nerve sheath tumor (MPNST).

Clinical discussion

Understanding the underlying causes of brachial plexopathy is crucial for accurate diagnosis, particularly in cancer patients and those with a history of radiotherapy, as these individuals may present with complex or atypical symptoms that can complicate the diagnostic process. In such cases, distinguishing between tumor-related brachial plexopathy, radiation-induced nerve damage, and other potential etiologies is essential for guiding appropriate treatment strategies and improving patient outcomes.

Conclusions

Comprehensive and prompt evaluation is crucial in cases of brachial plexopathy with a history of cancer, aiming to prevent misdiagnosis and minimize complications.