Atypical spinal epidural capillary hemangioma: Case report

Abstract

Background:Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature.Case Description:A 69-year-old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9-T10 level. Following a T9-T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma.Conclusions:Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.

Rapid growth of spinal epidural capillary hemangioma associated with isolated intraosseous lesion at the same level: A case report

“…Most spinal epidural hemangiomas are cavernous hemangiomas, although 20 cases of spinal epidural capillary hemangioma (SECH) have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Most SECH cases had foraminal extension, which easily allowed differentiation from cavernous hemangioma. 9 SECH cases tended to occur in the thoracic levels and were rare in the lumbosacral regions.…”

Spinal Capillary Hemangioma: A Rare Benign Extradural Tumor

“…Hemangiomas are congenital vascular malformations, classified according to the predominant vascular morphology: cavernous, capillary, arteriovenous, or venous. 1,2 Capillary hemangiomas are the most common subtype overall as they occur frequently in skin and oral mucosa of infants and children. Spinal capillary epidural hemangiomas on the other hand are exceedingly rare, with fewer than 20 reported cases in the literature.…”

“…Spinal capillary epidural hemangiomas on the other hand are exceedingly rare, with fewer than 20 reported cases in the literature. 1,[3][4][5][6][7][8] They are benign tumors, described at all spinal levels, with a marked preponderance at the thoracic level. 8 The classical clinical presentation is one of spinal pain, radiculopathy, or subacute to chronic myelopathy.…”

“…The acute syndrome of intratumoral hematoma is distinctly uncommon with capillary hemangiomas, in contrast to the cavernous subtype. 1,8,9 MRI spine with gadolinium is the imaging modality of choice. It typically demonstrates an iso-or hypointense lesion on T1weighted images, hyperintensity on T2-weighted images, and homogenous enhancement following gadolinium administration.…”

“…2 These imaging features are not specific, and the differential diagnosis of an enhancing epidural soft tissue mass should include plasmacytoma, lymphoma, and other tumors such as hemangioblastoma, hemangioendothelioma hemangiopericytoma, meningioma, schwannoma, and neurofibroma, which, though typically intradural, can occur in a predominant extradural location. 1,2,5,8 Surgical en bloc resection is the treatment of choice, with a very favorable functional prognosis if performed early. 4 Spinal epidural capillary hemangioma should be considered in patients presenting with thoracic myelopathy and MRI findings of a strongly enhancing circumscribed extradural mass with flow voids.…”