DIAGNOSIS PROCESS AND MANAGEMENT OF SCIATIC NEURALGIA REVEALING A LUNG ADENOCARCINOMA, A CASE REPORT

Sciatic neuralgia is commonly due to lumbar disc herniation. However, malignancy infiltration of the nerves roots must also be considered. When metastasis is revealed by complication, its management must follow a particular approach. Authors report one case of sacral metastasis of a lung adenocarcinoma revealed by neuralgia and skeletal related events, worsening the patient’s life quality. One 65-year-old man experienced progressive and persistant left buttock pain beginning six months earlier, that radiated to the lower limb following the sciatic path. Progression of its intensity led to step limitation and disabilities.             Thoracolumbosacral Spine CT scan showed a huge tumoral mass with osteolytic process infiltrating all the sacrococcygeal area (113x112x107 mm) and a malignant vertebral collapse of L1. Pelvic organ investigations didn’t find any neoplasm. The full body CT scan found a heterogeneous nodule (21x11 mm) in the left apical lung lobe. Histopathology after biopsy of the sacral mass and the pulmonary nodule confirmed the adenocarcinoma and immunohistochemistry specified its lung origin. Surgical sciatic nerves decompression, radiotherapy and chemotherapy had increased survival time and pain improvement.