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LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 4  |  Page : 610-611

Epithelioid hemangioma of the thoracic spine


1 Department of Neurosurgery, Firat University, School of Medicine, Elazig, Turkey
2 Department of Pathology, Firat University, School of Medicine, Elazig, Turkey

Date of Web Publication4-Aug-2015

Correspondence Address:
Sait Ozturk
Department of Neurosurgery, Firat University, School of Medicine, Elazig
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.162082

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How to cite this article:
Akgun B, Ozturk S, Ucer O, Erol FS. Epithelioid hemangioma of the thoracic spine. Neurol India 2015;63:610-1

How to cite this URL:
Akgun B, Ozturk S, Ucer O, Erol FS. Epithelioid hemangioma of the thoracic spine. Neurol India [serial online] 2015 [cited 2019 Sep 22];63:610-1. Available from: http://www.neurologyindia.com/text.asp?2015/63/4/610/162082


Sir,

Epithelioid hemangiomas (EHs) are vascular tumors. They have been reported in the bones. Spinal EHs are rare. [1],[2]

A 19-year-old lady presented with sudden loss of strength in lower limbs. The power in her right and left lower extremities were 2/5 and 3/5, respectively. Destructive changes were detected in the T8 vertebral body on thoracic magnetic resonance imaging (MRI). At the same level, a right-sided lesion affecting the posterior elements was compressing the thecal sac [Figure 1]. The patient immediately underwent surgery. The posterolateral lesion was excised. Due to the lack of malignant cells in the frozen samples and excessive hemorrhage during surgery, a corpectomy was not performed. Posterior fusion was performed between T7 and T9 vertebral levels. Based on the histopathological findings, the patient was diagnosed as having an EH of the vertebra [Figure 2] and [Figure 3]. The neurologic examination on postoperative day 10 revealed no neurological deficits. MRI taken 6 months after surgery showed no recurrence and no compression on the thecal sac from the right posterolateral region of the vertebral body [Figure 4]. The patient was placed on a regular follow up.
Figure 1: In the preoperative magnetic resonance imaging, a lesion causing destructive changes in the T8 vertebral body, compressing the thecal sac and the right posterior vertebral body elements at the same level and extending to the paraspinal soft tissue is observed. (a) T1 weighted sagittal, (b) T2 weighted sagittal, (c) contrasted sagittal, (d) T2 weighted axial images showing the lesion

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Figure 2: In the histopathologic examination, (a) vascular structures are observed in various sizes among the bone trabecula (H and E, ×200). (b) Plenty of vascular structures with visible lumen surrounded by inflammatory cells are observed (H and E, ×200). (c) The magnified view (H and E, ×400)

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Figure 3: (a) Positive staining is observed with CD34 (Immunoperoxidase, ×200); and, (b) with CD31 (Immunoperoxidase, ×400)

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Figure 4: Imaging at a follow up of 6 months: (a) T1 weighted sagittal, (b) T2 weighted sagittal, (c) contrast sagittal, (d) T2 weighted axial sections, showing that there was no recurrence from the anterior or the right posterolateral vertebral body and no compression on the thecal sac. Artifact produced by the metal used for fusion is evident

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Spinal EH are benign but locally aggressive lesions. [1],[2],[3],[4] This is in contrast to epitheloid hemangiotheliomas and angiosarcomas that are low and high grade malignant neoplasms, respectively, of vascular origin [Table 1]. [1],[2],[4]
Table 1: Clinical and histopathological features of spinal tumors of vascular origin

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Surgical intervention may be required in the cases having thecal compression or spinal instability. Tumors that are not aggressive should be followed up at regular intervals. [2]

As their surgical excision carries the risk of excessive bleeding, minimally invasive treatment modalities such as percutaneous vertebroplasty or sclerotherapy have been reported for painful vertebral hemangiomas that are not aggressive. [2],[3] Some authors have recommended en bloc resection for malignant lesions in this location. An en bloc excision is, however, unnecessary for benign tumors like an EH because of the risk of neurological deterioration involved. [2],[3] In the present case also, the thecal compression was mainly from the right posterolateral side with no compression from the anterior aspect. No malignant cells were detected on frozen section. The hemorrhagic nature of the lesion further led us to opt for a more conservative resection and a radical procedure like a corpectomy was not performed. Considering the loss of vertebral body height and the involvement of the facet joints at the level of the lesion, a posterior vertebral fusion was also performed.


 » Acknowledgment Top


We thank Mr. Ramazan Cakmak for his technical support during the preparation of the figures.

 
 » References Top

1.
Sirikulchayanonta V, Jinawath A, Jaovisidha S. Epithelioid hemangioma involving three contiguous bones: A case report with a review of the literature. Korean J Radiol 2010;11:692-6.  Back to cited text no. 1
    
2.
Boyaci B, Hornicek FJ, Nielsen GP, DeLaney TF, Pedlow FX Jr, Mansfield FL, et al. Epithelioid hemangioma of the spine: A case series of six patients and review of the literature. Spine J 2013;13:e7-13.  Back to cited text no. 2
    
3.
Alexander J, Meir A, Vrodos N, Yau YH. Vertebral hemangioma: An important differential in the evaluation of locally aggressive spinal lesions. Spine (Phila Pa 1976) 2010;35:E917-20.  Back to cited text no. 3
    
4.
Rosenberg AE, Bovee JV, Hameed M, Wold LE, Rosenberg AE, Antonescu CR. Vascular tumors. In: Fletcher CD, Bridge JA, Hogendoorn PC, Mertens F, editors. WHO Classification of Tumors of Soft Tissue and Bone. 4 th ed. Lyon: IARC Press; 2012. p. 331-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]

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[Pubmed] | [DOI]



 

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