Disclosures: Colin K. Chen, DO: No financial relationships or conflicts of interest

Case Diagnosis: Patient found to have large pelvic mass compressing her right lumbosacral plexus.

Case Description or Program Description: A 68-year-old female with history of spinal stenosis and well-differentiated stage Ia grade 1 endometrial adenocarcinoma status post total laparoscopic hysterectomy and bilateral salpingo-oophorectomy presents to clinic with right lower extremity weakness, low back pain, and right thigh pain, swelling, and numbness gradually worsening over two months, affecting activities of daily living. Patient reports minor relief from Gabapentin and Prednisone. On examination, there is tenderness of the anterior right thigh and right groin. Hip flexion is 2/5 on the right, 4/5 on the left; knee extension is 4/5 bilaterally. Distal lower extremity strength is 5/5 bilaterally. Sensation to light touch is decreased on the right lower extremity along the L3 and L4 dermatomes. There is bilateral ankle clonus.

Setting: Outpatient Physiatry clinic.

Assessment/Results: Non-contrast lumbar MRI reveals large pelvic mass involving portion of the right iliopsoas muscle contacting lateral nerve roots of the lumbosacral plexus. Core needle biopsy of mass confirms adenocarcinoma of endometrial origin. Further developments will be discussed.

Discussion (relevance): In patients with history of pelvic neoplasm, neoplastic processes involving adjacent pelvic structures must be considered in new lumbosacral plexopathies. Plexopathy is typically unilateral. Clinical syndromes may present with upper plexus (L1-L4), lumbosacral trunk (L4-L5), or lower plexus (S1-4) involvement. Pain is a predominant symptom with lumbosacral plexopathy, followed by numbness and weakness. MRI is the most sensitive and preferred imaging modality.

Conclusions: In patients with spinal stenosis and history of pelvic neoplasm who present with new onset pain, weakness, numbness, and tingling, clinical suspicion of neoplastic etiology for progressive symptoms is high on the differential. Patients with neoplastic plexopathies have a poor prognosis and shorter life expectancy, as presence indicates advanced cancer stage.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lumbosacral-plexopathy-from-pelvic-tumor-mass-effect-a-case-report/