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Case Reports
. 2025 Mar 3;17(3):e79995.
doi: 10.7759/cureus.79995. eCollection 2025 Mar.

Rapidly Growing Malignant Peripheral Nerve Sheath Tumors Arising From Neurofibromatosis Type 1: A Case Report by Rehabilitation Physicians

Koji Hayashi  1 , Yuka Nakaya  1 , Toyoaki Miura  1 , Asuka Suzuki  1 , Hiroaki Maeda  1 , Mamiko Sato  1 , Yasutaka Kobayashi  2
Affiliations
Case Reports

Rapidly Growing Malignant Peripheral Nerve Sheath Tumors Arising From Neurofibromatosis Type 1: A Case Report by Rehabilitation Physicians

Koji Hayashi et al. Cureus. .

Abstract

We describe a case of a 40-year-old Japanese woman with rapidly growing malignant peripheral nerve sheath tumors (MPNSTs) arising from neurofibromatosis type 1 (NF-1). The patient presented numbness in both legs, back pain, and gait disturbances. Magnetic resonance imaging (MRI) revealed a spinal tumor at the thoracic level. To resolve her symptoms, a laminectomy and intradural tumor resection were performed. The tumor was diagnosed as a neurofibroma with no malignant characteristics. After the surgery, she participated in a rehabilitation program aimed at promoting independence in daily activities and enhancing muscle strength. Initially, her walking ability showed improvement; however, she soon experienced complications, including challenges with bowel movements and a gradual decline in her walking function. A follow-up MRI on the 67th day post-surgery showed tumor regrowth that necessitated reoperation. After the surgery, the neurological symptoms improved temporarily, but they worsened again, ultimately leading to a shift to palliative care and her demise several days later. This case underscores the challenges in pathological diagnosis and the aggressive nature of MPNSTs, emphasizing the need for vigilant monitoring and timely intervention. Despite initial surgical success, rapid tumor growth can occur during rehabilitation, highlighting the importance of a multidisciplinary approach for accurate diagnosis and treatment. Early detection of tumor progression through meticulous neurological monitoring and prompt surgical consultation are critical for optimal outcomes. Further research into more definitive diagnostic tools and effective treatment strategies for MPNSTs is crucial to improve patient care.

Keywords: malignant peripheral nerve sheath tumor (mpnst); malignant spinal tumor; nerve schwannoma; neurofibromatosis type 1 (nf-1); spinal cord tumor.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Thoracic magnetic resonance imaging on admission at the previous hospital.
T2-weighted thoracic spine MRI revealed a spinal tumor located in the left thoracic spinal cord at the Th9-10 level (arrow).
Figure 2
Figure 2. Follow-up MRI on day 70 after the initial surgery.
(A) Thoracic spine MRI using T2-weighted imaging (coronal section) revealed a mass measuring 63 x 55 mm extending from the Th9 vertebral body, arch, and epidural space to the left posterior mediastinum through the left foramina of Th9/10 (arrow). (B) T1-weighted thoracic spine MRI revealed a lobulated mass with hypointensity (arrow). (C) T2-weighted thoracic spine MRI showed a lobulated mass with hypointensity, accompanied by uneven abnormal signals within the mass (arrow).
Figure 3
Figure 3. Follow-up thoracic spine MRI on the 126th day.
The MRI revealed significant tumor enlargement (diameter 98 mm) with lobulation (yellow arrow). Pleural effusion (white arrow) and collapsed lungs (red arrow) were also noted. Additionally, the skin surface exhibited numerous tumors associated with neurofibromatosis type 1.
See this image and copyright information in PMC

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