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Villanueva-Castro E, Ramírez-Aragón S, Del Pino-Camposeco J, Canela-Calderon O, Ponce-Gómez JA, Arriada-Mendicoa JN. Spinal Cord Syndrome Due to Extramedullary Epithelioid Hemangioendothelioma of the Thoracic Spine: A Case Report and Literature Review. Cureus 2024; 16:e58571. [PMID: 38765371 PMCID: PMC11102575 DOI: 10.7759/cureus.58571] [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] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
We report a 48-year-old male patient with spinal epithelioid hemangioendothelioma in T3 and T4 who began with symptoms of paresthesia in the lower limbs and distal weakness of the right lower limb, back pain, increased limitation in walking, urinary incontinence, and constipation. A safe maximum resection was performed, finding residual disease during the PET/CT scan, so it was decided to treat with radiotherapy, and there was a good response to this treatment. A literature review of epithelioid hemangioendothelioma of the thoracic spine was done which showed a mean age of presentation of 41 years and a male-female ratio of 1:0.53. The main symptom was pain, which was present in 100% of the patients, and wide surgery was performed in 56.8% of the patients, intralesional surgery in 31.8%, and biopsy in 11.4%. A total of 46.6% of patients received radiation therapy, and only 6.6% received chemotherapy. The patients had an average follow-up of 38 months. We recommend that extension studies such as PET/CT scans be performed after surgical resection. This can serve as a follow-up with hemangioendothelioma epithelioma patients about metastatic disease or residual disease that will guide us in giving adjuvant treatments, such as radiotherapy or chemotherapy, for better control of the disease.
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Affiliation(s)
- Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Ramírez-Ferrer E, Perez F, Caballero A, Riveros WM, Osorio-Bohorquez LA. Focal, Extranodal Primary Polymorphous Hemangioendothelioma Treated With Endovascular Embolization and Resection Surgery. Cureus 2021; 13:e19756. [PMID: 34950543 PMCID: PMC8687796 DOI: 10.7759/cureus.19756] [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] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
A male 28-year-old patient complained of a dorsal mass that has been increasing in size in the last six months. The mass was painful, soft, no mobile, and no neurological symptoms or signs were documented. A vascular-type tumor was suspected and endovascular followed by open surgical resection was indicated. Histopathological revealed a rare case of an adult with a primary extranodal polymorphous hemangioendothelioma. Total resection was confirmed by tumor-free resection margin. The postoperative course was uneventful. Polymorph hemangioendothelioma is a rare vascular tumor. Preoperative endovascular embolization is recommended given the high vascular features of the lesion and, therefore, the high rate of bleeding during surgery, to achieve complete resection.
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Affiliation(s)
- Esteban Ramírez-Ferrer
- Neurological Surgery, Center for Research and Training in Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL
| | - Francisco Perez
- Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL
| | - Alberto Caballero
- Neurological Endovascular Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Endovascular Surgery, Center for Research and Training in Neurosurgery (CIEN), Bogotá, COL
| | - William Mauricio Riveros
- Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL
| | - Luis Alejandro Osorio-Bohorquez
- Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL.,Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL
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Bhatt AS, Muthusubramanian V, Kondappan A, Mahadevan A. Intradural Hemangioendothelioma of Lumbar Spine: Dilemmas and Differentials in Diagnosis. World Neurosurg 2019; 130:479-483. [PMID: 31295588 DOI: 10.1016/j.wneu.2019.06.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vascular tumors of the spine range from benign hemangiomas to malignant angiosarcomas. Hemangioendotheliomas of spine are tumors of intermediate-grade malignancy with rare occurrence in the intradural location. The imaging and histopathologic features may mimic other common lesions occurring at this location. CASE DESCRIPTION A 70-year-old woman presented with lower limb weakness and sensory impairment along the L5-S1 dermatome. A radiologic diagnosis of neurofibroma at the intradural location of the L4-L5 level was made, and total excision of the space-occupying lesion was done. Histopathologic examination, however, revealed a vascular tumor consistent with hemangioendothelioma, which was confirmed by immunohistochemical analysis. We present this case discussing the dilemmas and difficulties in arriving at the diagnosis, highlighting the role of immunohistochemical aid. CONCLUSION Histomorphology, aided by ancillar tests like immunohistochemistry, remains the criterion for the definitive diagnosis of such rare lesions, and pathologists need to be aware of these lesions occurring in uncommon locations.
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Affiliation(s)
- Anusha S Bhatt
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vikram Muthusubramanian
- Department of Minimally Invasive Brain and Spine Surgery, Sri Ramakrishna Hospitals, Coimbatore, India
| | - Asokan Kondappan
- Department of Neurology, Sri Ramakrishna Hospitals, Coimbatore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Munson TA, Valyi-Nagy T, Utset M, Lewis Z, Amin-Hanjani S. Intramedullary hobnail hemangioendothelioma of the conus. J Neurosurg Spine 2013; 18:515-8. [PMID: 23521687 DOI: 10.3171/2013.2.spine12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hemangioendotheliomas have only rarely been encountered in the neuraxis. Here, the authors present a case of an intramedullary hobnail hemangioendothelioma of the spinal cord, the first case described of this particular pathological entity in the neuraxis. The authors discuss their treatment and review the pertinent literature regarding management.
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Affiliation(s)
- Troy A Munson
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, MC-799, Chicago, Illinois 60612, USA
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Kerry G, Marx O, Kraus D, Vogel M, Kaiser A, Ruedinger C, Steiner HH. Multifocal epithelioid hemangioendothelioma derived from the spine region: case report and literature review. Case Rep Oncol 2012; 5:91-8. [PMID: 22539920 PMCID: PMC3337738 DOI: 10.1159/000336947] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with malignant biological behavior. It arises from endothelial cells, usually within soft tissues, and can occur in almost all locations. Case Report We report a unique case of a 25-year-old man who presented with sudden attacks of severe back pain followed by acute non-traumatic paraplegia. Emergency diagnostics revealed a pathologic fracture of the T7 vertebra with tumor tissue invasion of the spinal canal. Furthermore, multifocal metastases were found. Results To achieve en bloc resection, interdisciplinary surgical approaches were indicated. Despite multimodal therapy concepts, including radiotherapy and chemotherapy as well as endovascular embolization, the patient died within 8 weeks. Conclusion Prognosis of EHE is unpredictable and mainly determined by its location. The lesions are potentially aggressive; therefore, en bloc resection should be attempted whenever possible. However, as shown in the literature, only 15% of patients are suitable for total resection.
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Affiliation(s)
- G Kerry
- Department of Neurosurgery, Klinikum Nuernberg, Nuremberg, Germany
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