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• W2145350003 abstract "The MR examination demonstrates a 6×2.5-cm pre-sacral mass lesion that is extending into and expanding the left S1 exit foramen. This mass extends into the epidural fat, displacing and partially surrounding the S1 nerve, but it did not extend distally to affect the exiting S2 or S3 nerves. The lesion shows a heterogeneous signal pattern on T1and T2weighted sequences with focal areas of high signal intensity on the T1-weighted sequences indicative of small areas of haemorrhage. The lesion is predominantly hyperintense to muscle on T2 weighting and following contrast medium administration, and a relatively uniform enhancement pattern is identified. Trans-sacral biopsy by an approach lateral to the exit foramen was performed to exclude recurrent rectal carcinoma. The biopsy material demonstrated endometriosis characterised by endometrial glands surrounded by endometrial stroma with strong positivity for oestrogen and progesterone. As a result, the patient was commenced on hormonal treatment and the neurological symptoms improved. Although endometriosis is a common condition affecting women of reproductive age, it may rarely affect both the central and peripheral nervous systems. The exact prevalence is unknown, but a greater number of cases affecting the peripheral nervous system have been reported, the commonest being the sciatic nerve [1]. Presentation is typically with cyclical pain in a sciatic distribution with sensory loss in the S1 dermatome and motor weakness. Symptoms may result from either direct compression or fibrosis of the nerve. The symptoms are usually progressive unless treated and prolonged compression can lead to irreversible damage. A number of theories have been postulated to explain the extra-uterine spread of endometriosis [2]. In the ovary, the commonest site of endometriosis outside of the uterus, lymphatic drainage from the uterus has been suggested to be the cause [3]. Distant sites of extra-pelvic endometriosis, such as the thorax or central nervous system, have been attributed to haematological transport, but coeloemic tissue metaplasia has also been postulated, as endometriosis can occur in patients who have never menstruated or even in post-menopausal women [4]. This has been refuted by other workers who have found asymmetric sciatic nerve endometriosis and diaphragmatic disease more commonly on the right side, supporting the menstrual reflux theory because of the transport of endometrial cells in the cycle of peritoneal fluid redistribution [5]. In the pelvis, the left The case presentation can be found at doi:10.1007/s00256-009-0831-6 I. Nagra : S. L. J. James (*) Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP, UK e-mail: steven.james@roh.nhs.uk" @default.
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• W2145350003 date "2009-11-26" @default.
• W2145350003 modified "2023-10-18" @default.
• W2145350003 title "A 45-year-old woman with a pre-sacral mass lesion: diagnosis and discussion" @default.
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• W2145350003 doi "https://doi.org/10.1007/s00256-009-0832-5" @default.
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