Korean J Pain.  2011 Dec;24(4):226-230. 10.3344/kjp.2011.24.4.226.

Lumbar Plexopathy Caused by Metastatic Tumor, Which Was Mistaken for Postoperative Femoral Neuropathy

• Lee KH
• Choe JH
• Lee SE
• Park JH
• Bang SR
• Kim YH
• Jeon SY

• KMID: 2074018
• DOI: http://doi.org/10.3344/kjp.2011.24.4.226

Abstract

Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.

Keyword

fibromatosis; liposarcoma; neuropathic pain

MeSH Terms

Female
Femoral Neuropathy
Fibroma
Humans
Hyperalgesia
Leg
Liposarcoma
Lumbosacral Plexus
Muscles
Neuralgia
Thigh

Figure

• 

  Fig. 1 Axial view (T2 WI) of thigh MRI shows intramuscular mass like lesion in left rectus femoris.

• 

  Fig. 2 Axial view (T1 WI) of L-spine MRI shows mass at left iliopsoas muscle.

• 

  Fig. 3 Coronal view of PET torso shows right suprarenal malignancy with multiple metastases to lungs, pleuras, left psoas muscle and peritoneal seeding.

Reference

1. Kehlet H, Rathmell JP. Persistent postsurgical pain: the path forward through better design of clinical studies. Anesthesiology. 2010; 112:514–515. PMID: 20124977.

2. Niraj G, Rowbotham DJ. Persistent postoperative pain: where are we now? Br J Anaesth. 2011; 107:25–29. PMID: 21610014.

3. Pechter EA, Smith PB. Transient femoral neuropathy after abdominoplasty. Ann Plast Surg. 2008; 61:492–493. PMID: 18948773.

4. Van Veer H, Coosemans W, Pirenne J, Monbaliu D. Acute femoral neuropathy: a rare complication after renal transplantation. Transplant Proc. 2010; 42:4384–4388. PMID: 21168704.

5. Wilson M, Ramage L, Yoong W, Swinhoe J. Femoral neuropathy after vaginal surgery: a complication of the lithotomy position. J Obstet Gynaecol. 2011; 31:90–91. PMID: 21281008.

6. Crombie IK, Davies HT, Macrae WA. Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain. 1998; 76:167–171. PMID: 9696470.

7. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367:1618–1625. PMID: 16698416.

8. Planner AC, Donaghy M, Moore NR. Causes of lumbosacral plexopathy. Clin Radiol. 2006; 61:987–995. PMID: 17097418.

9. Lee GH. The Korean pain society. Disc herniation. Pain medicine. 2007. 3rd ed. Seoul: Koonja Publishing Inc;p. 271–277.

10. Al-Ajmi A, Rousseff RT, Khuraibet AJ. Iatrogenic femoral neuropathy: two cases and literature update. J Clin Neuromuscul Dis. 2010; 12:66–75. PMID: 21386773.

11. Tong HC. Specificity of needle electromyography for lumbar radiculopathy in 55- to 79-yr-old subjects with low back pain and sciatica without stenosis. Am J Phys Med Rehabil. 2011; 90:233–238. PMID: 21297400.

12. Prendergast B, Fiveash JB, Gibbs CP, Scarborough MT, Indelicato DJ. Radiotherapy for soft tissue sarcoma of the proximal lower extremity. Sarcoma. 2010; 2010:829498. PMID: 20981344.

13. Mackenzie DH. The fibromatoses: a clinicopathological concept. Br Med J. 1972; 4:277–281. PMID: 4563457.