以坐骨神經痛爲初始臨床表現的後腹腔巨大脂肪肉瘤：病例報告

後腹腔脂肪肉瘤腫瘤常因壓迫附近構造引起腸胃道或泌尿道的症狀，但是壓迫腰薦神經造成坐骨神經痛卻十分少見。當患者以坐骨神經痛前來就診，除了常見椎間盤的病變之外，腰薦部位神經也可能因爲其他構造的壓迫而產生症狀，後腹腔腫瘤即是其中一種罕見之鑑別診斷。我們報告一個後腹腔腫瘤以坐骨神經痛爲初始臨床表現。這位二十九歲年輕男性，以左膝疼痛、左小腿外側痛爲症狀持續半年，經診斷爲坐骨神經痛，接受一個多月的腰椎牽引治療，但症狀沒有改善。後來經影像學檢查發現在後腹腔有一個巨大腫瘤，此腫瘤侵入腰椎第三節至第五節的神經孔並且包圍住腰薦椎段的神經束，其病理報告顯示爲黏液及圓細胞型脂肪肉瘤。回顧近期國內文獻，並未看到後腹腔脂肪肉瘤造成坐骨神經痛的病例報告。

關鍵字

脂肪肉瘤；後腹腔；坐骨神經痛

並列摘要

Background: Retroperitoneal liposarcoma is one of the common soft-tissue tumors that occur in the retroperitoneal cavity. It often invades adjacent structures and causes symptoms of gastrointestinal or urinary tract infection. However, it rarely causes sciatica by compressing the lumbosarcral nerve roots. A recent review of the domestic literatures revealed that this is the first case report on sciatica caused by retroperitoneal liposarcoma. Case: We present the case of a 29-year-old man who complained of left knee pain for half a year. The pain gradually progressed to his left lateral calf. Sciatica was suspected based on his clinical symptoms and electrodiagnostic studies. However, despite undergoing a 6-week program of intermittent pelvic traction, the patient’s symptoms did not improve. Magnetic resonance imaging revealed a huge retroperitoneal tumor sized 18 cm × 13 cm × 10 cm. Surgical excision of the tumor was performed, and the operative findings included a large tumor with jelly-like content in the retroperitoneum and intra-psoas muscle with nerve bundle encasement. Pathological findings revealed myxoid/round cell type liposarcoma. Conclusion: If sciatica is suspected on the basis of clinical findings, the nerve roots may be compressed by causes other than vertebral spurs or herniated discs. Retroperitoneal tumor may be one of the differential diagnoses. The epidemiology, pathology, treatment, and prognosis of retroperitoneal liposarcoma are discussed in this case report.

並列關鍵字

liposarcoma ； retroperitoneal ； sciatica

國際替代計量

以坐骨神經痛爲初始臨床表現的後腹腔巨大脂肪肉瘤：病例報告

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