A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis

Bone Metastasis from Renal Cancer Coinciding with the Same Anatomical Position as a Vertebral Hemangioma: A Collision Lesion Case Report

Collisions lesions are rare neoplasms where two histologically distinct tumors coexist in the same organ or anatomical site. Vertebral hemangiomas (VHs) are the most common lesions involving the vertebral bodies and imaging findings of typical and atypical hemangiomas, variant forms of hemangioma such as aggressive hemangiomas are well known, but collision lesions involving VHs are extremely rare. This article presents a case report of a 73-year-old male patient diagnosed with clear cell renal cancer in a rare presentation of a bone metastasis coinciding with the same anatomical position as a VH (collision lesion). This required a multidisciplinary approach involving various diagnostic techniques to determine the best therapeutic management.

In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate

STUDY DESIGN

This was a retrospective study.

PURPOSE

To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate.

OVERVIEW OF LITERATURE

AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients.

METHODS

Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.

RESULTS

Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months).

CONCLUSIONS

In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection.

Thoracic spine hemangioma causing rapidly progressive myelopathy and mimicking a malignant tumor: A case report

Vertebral hemangiomas are common benign tumors that are mostly asymptomatic and are discovered incidentally. Only 0.9–1.2% of all vertebral hemangiomas, termed aggressive vertebral hemangiomas, expand to cause pain and neural compression. We present an extremely rare case of a 49-year-old woman who had an aggressive vertebral hemangioma of the thoracic spine that caused rapidly progressive myelopathy with remarkable irregular extraosseous bone proliferation, which mimicked a malignant vertebral tumor. In this case, despite the lesion's hostile appearance during imaging, the pathological diagnosis was benign and symptom-based surgical treatment with posterior decompression and stabilization provided good clinical outcomes during the postoperative 18 months follow-up period. In this case, despite the use of standard imaging modalities (radiograph, CT, and MRI), making a preoperative imaging diagnosis of an aggressive vertebral hemangioma was difficult, and although aggressive vertebral hemangiomas with atypical radiological features are rare, they should be considered as a differential diagnosis.

Atypical Radiographic Features of Aggressive Vertebral Hemangiomas

BACKGROUND

Vertebral hemangioma (VH) is one of the most common benign spinal tumors and can be aggressive in some cases. While most aggressive VHs have typical radiographic features, including vertical striations, a honeycomb appearance, and/or a "polka-dot sign" in computed tomography (CT) scans, cases with atypical features might complicate diagnosis. This study aimed to determine the range and frequency of these atypical features.

METHODS

In this retrospective study, to identify the typical and atypical features of aggressive VH, pretreatment CT and magnetic resonance imaging (MRI) were reviewed retrospectively by 1 radiologist and 1 orthopaedic surgeon. Percutaneous biopsies were performed to confirm the VH in atypical cases.

RESULTS

A total of 95 patients with aggressive VHs were treated in our hospital from January 2005 to December 2017. Thirty-four (36%) of the lesions showed at least 1 atypical radiographic feature: 16 patients (17%) had a vertebral compression fracture, 11 patients (12%) had expansive and/or osteolytic bone destruction without a honeycomb appearance and/or "polka-dot sign", 11 patients (12%) had obvious epidural osseous compression of the spinal cord, 12 patients (13%) had involvement of >1 segment, 9 patients (10%) had a VH centered in the pedicle and/or lamina, and 8 patients (8%) had atypical MRI signals. Forty-three patients underwent percutaneous biopsies, which had an accuracy of 86%.

CONCLUSIONS

Based on radiographic analysis, aggressive VH can be classified as typical or atypical. More than one-third of aggressive VH lesions may have at least 1 atypical feature. CT-guided biopsies are indicated for these atypical cases.

Computed Tomography and Magnetic Resonance Imaging Manifestations of Spinal Monostotic Fibrous Dysplasia

Aim:

The purpose of the study was to analyze and summarize the computed tomography (CT) and magnetic resonance imaging (MRI) findings of spinal monostotic fibrous dysplasia (MFD) as well as evaluate the clinical value of CT and MRI in MFD diagnosis.

Materials and Methods:

CT (n = 4) and MRI (n = 5) images of six patients with pathologically confirmed spinal MFD were examined. The assessed image features included location, shape, rib involvement, vertebral collapse, margin, attenuation, and sclerotic rim on CT, as well as signal intensity, dark signal rim, and enhancement pattern on MRI.

Results:

In total, four of six patients underwent CT scanning. The most common findings on CT scanning were expansile lesions (n = 4), sclerotic rims (n = 4), and ground-glass opacity (GGO) (n = 4). In total, five of six patients underwent MRI. The lesions were low-signal intensity (n = 2), low-to-isointense signal intensity (n = 1), and low-signal intensity with several isointense portions (n = 2) on T1-weighted imaging (T1WI). The lesions were low-signal intensity (n = 1), isointense to high intensity (n = 1), and isointense signal intensity with several high portions (n = 3) on T2WI. A dark signal rim was found in most cases on T1WI and T2WI (n = 4). The lesions (n = 2) showed obvious enhancement.

Conclusions:

The CT and MRI manifestations of spinal MFD have the following characteristics: expansile lesion, GGO, sclerotic rim, and no obvious soft-tissue mass. The combined use of CT and MRI examinations is necessary for patients with suspected spinal MFD.