Cervical epidural lymphangioma presenting as a hemorrhagic cyst: a case report

Spinal lymphangiomas: Case-based review of a chameleonic disease entity

Purpose

Lymphangiomas are benign hamartomas in the spectrum of lymphatic malformations, exhibiting multifaceted clinical features. Spinal involvement is exceedingly rare, with only 35 cases reported to date. Both due to their rarity and chameleonic radiologic features, spinal lymphangiomas (SLs) are usually misdiagnosed; postoperatively, surgeons are thus confronted with an unexpected histopathological diagnosis with sparse pertinent literature and no treatment guidelines available.

Methods

Here, we report the case of a 67-year-old female who underwent surgery for a T6-T7 epidural SL with transforaminal extension, manifesting with spastic paraparesis. Then, we present the results of the first systematic review of the literature on this subject, delineating the clinical and imaging features and the therapeutic implications of this rare disease entity.

Results

Our patient was treated with T6-T7 hemilaminectomy and resection of the epidural mass, with complete recovery of her neurological picture. No recurrence was evident at 18 months. In the literature, 35 cases of SL were reported that can be classified as vertebral SL (n = 18), epidural SL (n = 10), intradural SL (n = 3), or intrathoracic lymphangiomas with secondary spinal involvement (n = 4). Specific treatment strategies (both surgical and nonsurgical) were adopted in relation to each of these categories.

Conclusion

Gathering knowledge about SL is fundamental to promote both correct preoperative identification and appropriate perioperative management of this rare disease entity. By reviewing the literature and discussing an exemplary case, we delineate a framework that can guide surgeons facing such an unfamiliar diagnosis.

Rare case of cystic hygroma in the epidural space resulting in multilevel spinal cord compression

Lymphangioma, or cystic hygroma, involving the epidural space and spinal soft tissue, is a rare benign lesion consisting of an abnormal collection of lymphatic tissue isolated from the normal lymphatic system. This case report is the most extensive case of cystic hygroma involving the spine reported in the literature. A 23-year-old man with a history of cystic hygromas of the neck and thorax presented with bilateral upper and lower extremity weakness that progressively worsened over 3 months. A left hemilaminectomy from C4 to T5 with endoscopic exploration and cyst drainage was performed. At last follow-up, the patient was ambulating and returned to work. Aggressive decompression of mass lesions resulting in myelopathy, such as the spinal cystic hygromas, resulted in improved motor function as well as overall function status.

Lymphangioma of the Thoracic Spine with Epidural Compression: A Case Report

Lymphangiomas are benign lesions consisting of abnormal proliferations of lymphatic vessels. Lymphangiomas associated with bone involvement, particularly in vertebral bodies, accompanied by cord compression, are extremely rare, and our literature review yielded only a few relevant reports. We describe a 61-year-old man presenting with progressive paraparesis and sphincter disturbance of 5 months' duration. Magnetic resonance imaging (MRI) revealed an enhancing T8 vertebral body involvement as well as a homogeneously enhancing posterior epidural mass at the T7-T8 level, with severe cord compression and cerebrospinal fluid (CSF) blockade. The patient underwent surgery via T7-T8 laminectomy, and after the removal of the epidural mass, the surgical procedure was stopped due to severe bleeding. Histopathologic examination reported a lymphangioma. After 10 days, the patient was able to walk. In the sixth postoperative month, MRI showed complete relief of the mass effect. The wide spectrum of the preoperative differential diagnosis of lymphangiomas renders a definite preoperative diagnosis impossible; therefore, histopathologic examination is the sole definite route for their diagnosis. In case of the solitary lymphangiomas of the spine with epidural compression, preoperative angiography and embolization should be considered to reduce intraoperative bleeding and enhance the chance of total resection and total surgical resection should be performed to decrease the likelihood of recurrence.

Intradural cavernous lymphangioma of the thoracic spine: case report, technical considerations, and review of the literature

BACKGROUND CONTEXT

Cavernous lymphangioma is a rare slow-growing tumor that can cause neurologic compromise when it involves the central nervous system. Involvement of the spinal column is rare but may involve the osseous structures or the epidural space of the spinal column.

PURPOSE

We report the first case of an intradural, extramedullary cavernous lymphangioma involving the thoracic spinal cord.

METHODS

An 83-year-old woman presented with progressive gait ataxia, bilateral lower extremity weakness, and a band-like sensation in the middle and lower thoracic dermatomes. Magnetic resonance imaging of the thoracic spinal cord revealed hyperintensity on T2 and enhancement of an intradural cystic mass along the dorsal aspect of the T5-T8 levels with significant compression of the spinal cord.

RESULTS

Complete surgical resection was difficult owing to the adherence of the tumor to the pial surface and microvasculature of the thoracic spinal cord. Recurrence of the mass was ultimately treated with cystic fluid diversion into the peritoneum. At her follow-up visit after 28 months, the patient was able to ambulate with minimal assistance. A comparative literature review is presented. There are no reports of intradural thoracic spinal cord involvement in the literature.

CONCLUSIONS

Intradural cavernous lymphangioma of the spine poses a unique surgical challenge for complete resection. Cystic fluid diversion appears to be a viable treatment option with lasting benefit if complete resection is not achieved.

Neck pseudo-bruising secondary to acute aortic dissection

We report a case of lethal acute aortic dissection revealed by a large ecchymotic area at the root of the neck; the subject was an 86-year-old man who died suddenly in his hospital room. His medical history included ischemic heart disease with pacemaker implantation and an aortic surgical prosthesis. Forensic autopsy showed a major subcutaneous hemorrhage in the neck and large left pleural and pericardial adhesions secondary to thoracic surgery. The cause of death was an acute aortic dissection. Large adhesions led to an extensive mediastinal hemorrhage, spreading to the subcutaneous tissues of the neck. This case report highlights the difficulties in differentiating between traumatic and pseudo-bruising during a death scene investigation. The etiologies of pseudo-bruising are reviewed.