Perianal Pain as a Presentation of Lumbosacral Neurofibroma: A Case Report

Abstract

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

Keywords

perianal pain - referral pain - neurofibroma - proctalgia

• References

• 1 Wesselmann U, Burnett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain 1997; 73 (3) 269-294
• 2 Kornel EE, Vlahakos D. Intraspinal schwannoma presenting solely with rectal pain. Neurosurgery 1988; 22 (2) 417-419
• 3 Haraguchi M, Kinoshita H, Koori M , et al. Multiple rectal carcinoids with diffuse ganglioneuromatosis. World J Surg Oncol 2007; 5: 19
• 4 Daniel WJ. Anorectal pain, bleeding and lumps. Aust Fam Physician 2010; 39 (6) 376-381
• 5 Harkin JC, Reed RJ. Tumors of the Peripheral Nervous System. Washington, DC: Armed Forces Institute of Pathology; 1969: 51-97
• 6 Seppälä MT, Haltia MJJ, Sankila RJ, Jääskeläinen JE, Heiskanen O. Long-term outcome after removal of spinal neurofibroma. J Neurosurg 1995; 82 (4) 572-577
• 7 Benerji AK. Epidemiology of CNS tumors 1974–1978. In: Proceedings of the National Seminar on Neurooncology. Bangalore, India: National Institute of Mental Health and Neurosciences; 1981: 111-143
• 8 Rao SB. Spinal neurinoma. A study of 80 operated cases. Neurol India 1975; 23 (1) 1-12
• 9 Das Gupta TK, Brasfield RD, Strong EW, Hajdu SI. Benign solitary schwannomas (neurilemomas). Cancer 1969; 24 (2) 355-366
• 10 Sanguinetti C, Specchia N, Gigante A, de Palma L, Greco F. Clinical and pathological aspects of solitary spinal neurofibroma. J Bone Joint Surg Br 1993; 75 (1) 141-147
• 11 Breidahl WH, Khangure MS. MRI of lumbar and sacral plexus nerve sheath tumours. Australas Radiol 1991; 35 (2) 140-144
• 12 Feldenzer JA, McGauley JL, McGillicuddy JE. Sacral and presacral tumors: problems in diagnosis and management. Neurosurgery 1989; 25 (6) 884-891
• 13 Zimmerman RA, Bilaniuk LT. Imaging of tumors of the spinal canal and cord. Radiol Clin North Am 1988; 26 (5) 965-1007
• 14 Argyrakis A, Teichmann A, Kuhn W. Solitary neurofibroma of the lumbosacral plexus. J Neurol Neurosurg Psychiatry 1985; 48 (8) 844-846
• 15 Barboriak DP, Rivitz SM, Chew FS. Sacral neurofibroma. AJR Am J Roentgenol 1992; 159 (3) 600