Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team

Few data exist regarding the outcomes in patients undergoing surgery for pelvic tumors of neurogenic origin. Our aim was to characterize the clinical and pathologic features of pelvic neurogenic tumors and assess surgical outcomes.

All patients who underwent operations for pelvic neurogenic tumors at our institution between 1956 and 2004 were identified. Data analyzed included demographics, clinical features, histopathology, local recurrence, and survival.

Eighty-nine patients were identified, of whom 44 were male. Median age was 38 years. The most common presenting symptom was low back or pelvic pain (56%). Malignant lesions were found in 43 patients (48%). Schwannomas were the most common benign tumor (61%) and malignant peripheral nerve sheath tumors the most common malignant lesion (81%). Median tumor size was 9.5 cm (range 0.8-32 cm). Malignant tumors had histopathologic evidence of infiltration of surrounding structures in 49% of cases. Intralesional resection was the most common surgical technique for both benign and malignant tumors. Thirty-day mortality was nil; major morbidity was seen in 13%. Adjuvant therapy was given to 91% of the patients with malignant disease. Five-year local recurrence rates for benign and malignant lesions were 35.9% and 35.0%, respectively. Distant recurrence for malignant lesions was 65.1% at 5 years. Five-year disease-free survival for malignant tumors was 25.9%.

Pelvic neurogenic tumors occurring in young patients may be large when detected and present with nonspecific symptoms. Benign and malignant tumors had a high local recurrence rate and survival for malignant tumors was poor. Early detection and aggressive surgical intervention should improve outcome.