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Sun J, Li J, Ayi Z, Yang F, Hu J, Hui X, Chen H, He J. Case report: A cystic capillary hemangioma located at the conus medullaris mimicking hemangioblastoma. Front Neurol 2024; 15:1350780. [PMID: 38606279 PMCID: PMC11006963 DOI: 10.3389/fneur.2024.1350780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Capillary hemangiomas, usually found in skin and mucosal tissues, are rarely encountered within the spinal cord, presenting a significant diagnostic challenge. We report a rare case of intradural extramedullary capillary hemangioma at the conus medullaris in a 66-year-old female patient. Our initial diagnosis leaned towards a cystic hemangioblastoma based on MRI findings due to the presence of cystic formation with an enhanced mural nodule. However, surgical exploration and subsequent pathological examination revealed the lesion as a capillary hemangioma. To the authors' knowledge, this case may represent the first documented instance of a spinal capillary hemangioma that mimics a cystic hemangioblastoma.
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Affiliation(s)
- Jiachen Sun
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiuhong Li
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ziba Ayi
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Feilong Yang
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Junlin Hu
- Department of Neurosurgery, People’s Hospital of Renshou, Meishan, China
| | - Xuhui Hui
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Haifeng Chen
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiaojiang He
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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Ghosn Y, Jabbour Y, Zeid FA, Jurdi N, Khouzami R, Moukaddam H. Massive spinal epidural infantile hemangioma, image findings, and treatment: a case report and review of literature. Skeletal Radiol 2024:10.1007/s00256-024-04570-1. [PMID: 38512366 DOI: 10.1007/s00256-024-04570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024]
Abstract
Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Farah Abou Zeid
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Nawaf Jurdi
- Department of Pathology, American University of Beirut, Beirut, Lebanon
| | - Riad Khouzami
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon.
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Benevello C, Laaidi A, Peeters S, Moiraghi A, Tauziede-Espariat A, Oppenheim C, Pallud J. Spinal epidural capillary hemangioma: a systematic literature review and an illustrative case. Neurochirurgie 2022; 68:697-701. [PMID: 35477014 DOI: 10.1016/j.neuchi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal hemangiomas are rare vascular malformations resulting from proliferation of vascular endothelial cells. The cavernous form is the most common and represents 5-12% of spinal vascular malformations, while the capillary form is rare. CASE DESCRIPTION A 56-year-old patient with no past medical history presented with progressive spinal cord compression symptoms localizing to the T10 level with MRC grade 4 proximal paraparesis. Preoperative MRI demonstrated a well-delineated, dumbbell-shaped, epidural lesion, without bony involvement, resulting in spinal cord compression at the T7 and T8 levels. The patient underwent gross total surgical resection of the lesion. At the one month follow up, the patient's strength improved to MRC grade 5, and sensation had fully returned. The histopathological diagnosis was a capillary hemangioma. Exclusively epidural capillary hemangiomas are extremely rare with only 26 cases reported in the literature. They are mainly located at the thoracic level (T4-T6). The MRI features include a well-circumscribed mass, hyperintense on T2-weighted sequence in 92% of cases, isointense on T1-weighted sequence in 88% of cases, and homogeneous contrast enhancement in 100% of cases. No tumor recurrence has been observed after gross total surgical removal. CONCLUSIONS When evaluating progressive spinal cord compression by a purely epidural spinal lesion, the differential diagnosis should include capillary hemangioma, in addition to schwannoma, meningioma, and lymphoma. Early and complete surgical removal is the first line treatment.
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Affiliation(s)
- C Benevello
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - A Laaidi
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - S Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Moiraghi
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France
| | - A Tauziede-Espariat
- Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Department of Neuropathology, GHU site Sainte-Anne, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France
| | - C Oppenheim
- Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France; Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
| | - J Pallud
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France.
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Akhaddar A. Comment regarding the article "Posttraumatic thoracic epidural capillary hemangioma". Surg Neurol Int 2020; 11:251. [PMID: 32905383 PMCID: PMC7468185 DOI: 10.25259/sni_438_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital of Marrakech and Mohammed V University in Rabat, Rabat, Morocco
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Rajpal S, Johs S, Zaronias C, Forsythe RC, Burneikiene S. Spinal Epidural Capillary Hemangioma With Intrathoracic Extension: Case Report and Review of the Literature. Cureus 2020; 12:e9358. [PMID: 32850229 PMCID: PMC7444968 DOI: 10.7759/cureus.9358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Capillary hemangiomas are hamartomatous congenital vascular malformations that are particularly uncommon in the spinal epidural space, and those with intrathoracic extensions are extremely rare. Although considered benign, capillary hemangiomas can cause rare hemorrhagic complications and risk of spinal cord compression or extension into the neural foramen. Therefore, surgery should be considered even in the absence of neurological symptoms. The literature reports three patients either underwent a partial resection or a complete tumor removal was achieved by accessing the lesion through a posterolateral approach and removing the costotransverse joint. The patient underwent a same-day, two-staged gross total resection of the tumor via combined posterior right-sided T7-T8 complete facetectomy and extradural mass resection with T7 nerve transection, followed by a posterolateral fusion of the T7-T8 vertebra. Stage 2 consisted of a video-assisted intrathoracic approach for the removal of the remaining tumor. The two-stage surgical procedure described in our case report allows for complete removal of intrathoracic and intraspinal portions of the mass with less morbidity.
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Affiliation(s)
- Sharad Rajpal
- Neurosurgery, Boulder Neurosurgical Associates, Boulder, USA
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Abstract
Capillary hemangiomas (CAs) are benign endothelial cell neoplasms that are often encountered superficially in the soft tissues of the head and neck region. Most of the reported purely spinal epidural hemangiomas have been of cavernous type, and the occurrence of purely spinal epidural CA is exceedingly rare, and there are only 12 reported cases of spinal epidural CAs in the English literature. Herein, the authors report the 13th case of purely spinal epidural CAs, and the clinical characteristics, histopathological features, and treatment were also investigated.
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Dumbbell-Shaped Epidural Capillary Hemangioma Presenting as a Lung Mass: Case Report and Review of the Literature. Spine (Phila Pa 1976) 2015; 40:E849-53. [PMID: 25946721 DOI: 10.1097/brs.0000000000000970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and literature review. OBJECTIVE We present the fourth case of a spinal epidural capillary hemangioma with a dumbbell-shaped appearance in the magnetic resonance image reported in the literature and the second presented as a lung mass. SUMMARY OF BACKGROUND DATA Hemangiomas are congenital vascular malformations that pathologists frequently consider to be hamartomatous malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can sit in other locations such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. METHODS We present a 67-year-old female with a thoracic dumbbell-shaped capillary hemangioma with both foraminal and intrathoracic extensions, whose presentation was pleural effusion associated with mediastinal mass suggestive of pulmonary neoplasia. Surgical treatment consisted of total removal en bloc of the lesion. RESULTS Microscopic evaluation showed a fibrofatty tissue with a proliferation of vascular structures that were generally of a small size, with areas of myxoid appearance. To date, there have been 8 epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature, and only 3 of them were dumbbell-shaped with extraforaminal extension. CONCLUSION It is important to consider the diagnosis of hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance image, especially at the thoracic level. It is a benign and potentially curable disease and the most appropriate surgical treatment is en bloc resection of the entire lesion. They are usually presented as a progressive myelopathy, so early treatment may prevent permanent neurological deficits. LEVEL OF EVIDENCE 5.
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Seferi A, Alimehmeti R, Vyshka G, Bushati T, Petrela M. Case study of a spinal epidural capillary hemangioma: a 4-year postoperative follow-up. Global Spine J 2014; 4:55-8. [PMID: 24494182 PMCID: PMC3908985 DOI: 10.1055/s-0033-1354251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/09/2013] [Indexed: 02/08/2023] Open
Abstract
Study Design Case study. Objectives We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings.
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Affiliation(s)
- Arsen Seferi
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Ridvan Alimehmeti
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Tirana, Tirana, Albania
- Address for correspondence Gentian Vyshka, MD Lagja 1, Rr. Kostaq CipoPall. 2/19, TiranaAlbania
| | - Teona Bushati
- Department of Pathological Anatomy, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Mentor Petrela
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
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Familial blue rubber bleb nevus syndrome in pregnancy with spinal epidural involvement. Case Rep Obstet Gynecol 2013; 2013:141506. [PMID: 23762681 PMCID: PMC3665244 DOI: 10.1155/2013/141506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations (VMs) of the skin, gastrointestinal tract, and other organs. To date, several cases of sporadic BRBNS involving various parts of the pregnant woman's body have been reported; however, BRBNS in pregnancy with spinal epidural involvement has not been reported. Here, we describe the clinical features and management of familial BRBNS in pregnancy. The patient presented with multiple VMs on her head, neck, floor of the mouth, trunk, leg, foot, and vulva and spinal epidural lesions. The patient's mother and sister also exhibited multiple VMs similar lesions, indicating a familial form of BRBNS. Cesarean section under general anesthesia was performed, and a healthy male neonate was delivered. The mother's postoperative course was uneventful and her VMs decreased in size after delivery. Physicians should consider the possibility of systemic diseases and familial inheritance in cases of VMs.
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Terry AR, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study. Neuro Oncol 2012; 14:768-76. [PMID: 22513749 PMCID: PMC3367848 DOI: 10.1093/neuonc/nos078] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 11/12/2022] Open
Abstract
Managing a CNS neoplasm during pregnancy presents complex challenges, and population-based studies are lacking. We designed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) to investigate pregnancy outcomes in women with CNS neoplasms. We constructed a logistic regression model for maternal mortality, preterm labor, intrauterine growth restriction (IUGR), and Caesarean delivery, controlling for age, comorbidities, and demographic characteristics. We identified 379 malignant brain tumors, 437 benign brain tumors, and 44 spine tumors among 19 million pregnancy-related admissions from 1988 through 2009. Malignant brain tumors were associated with maternal mortality (odds ratio [OR], 143), preterm labor (OR, 3.4), and IUGR (OR, 2.9). Benign brain tumors were associated with preterm labor (OR, 2.3). A diagnosis of hyperemesis gravidarum was more common in malignant (OR, 2.2) and benign (OR, 2.8) brain tumors. Compared with the general population, Caesarean delivery was more frequent for malignant (OR, 6.4) and benign (OR, 2.8) brain tumors and spine tumors (OR, 3.9). Admission without delivery was more common for malignant (OR, 8.6) and benign (OR, 4.3) brain tumors and spine tumors (OR, 3.8; P < .05 for all outcomes). Thirty-three percent of all hospitalizations involved neurosurgical procedures, but pregnancy complications were not significantly more likely to occur in surgical patients. In conclusion, malignant brain tumors were associated with adverse pregnancy outcomes, and CNS neoplasms were associated with higher rates of Caesarean delivery. Additional research is needed to improve understanding of obstetric risk in these patients and to assist with treatment, counseling, and monitoring during delivery.
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Affiliation(s)
- Anna R Terry
- Neurosurgical Service, White 502, Massachusetts General Hospital, Boston, MA 02114, USA.
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