Long-term outcome following surgical and radiation treatment of vertebral angiomatosis in a cat

Abstract

CASE DESCRIPTION A 2-year-old 5.2-kg (11.4-lb) neutered male domestic shorthair cat was referred because of a 6-week history of progressive paraparesis. CLINICAL FINDINGS Neurologic examination revealed moderate ambulatory paraparesis with marked spinal hyperesthesia at the thoracolumbar junction. The lesion was localized to the T3-L3 spinal cord segment. Clinicopathologic testing, thoracic radiography, and abdominal ultrasonography revealed no abnormalities to explain the observed clinical signs. Advanced spinal imaging with MRI revealed an extradural right-lateralized mass originating from the L2 vertebral pedicle and causing severe spinal cord compression. TREATMENT AND OUTCOME Surgical decompression was achieved by performance of a right-sided hemilaminectomy at L2. Histologic examination of biopsy samples obtained from the mass revealed an ill-defined zone of mature vascular proliferation extending through the preexisting vertebral bone, consistent with vertebral angiomatosis. After surgical recovery, adjuvant radiation therapy was initiated with a total dose of 48 Gy administered in 16 fractions of 3 Gy each over a 3-week period. Neurologic function rapidly improved to full ambulation with only minimal monoparesis of the right pelvic limb. Results of neurologic and MRI examination performed 26 months after surgery indicated no change in neurologic status or evidence of recurrence. CLINICAL RELEVANCE To the authors' knowledge, this report was the first to describe the long-term outcome for vertebral angiomatosis in a cat. Surgical decompression and radiation therapy provided an excellent outcome in this case. Vertebral angiomatosis should be considered as a differential diagnosis for any young cat with thoracolumbar myelopathy secondary to a mass associated with the vertebral pedicle.

Canine disseminated peritoneal angiomatosis with arterial differentiation in a 10‐month‐old Rhodesian Ridgeback

“…It is considered to be a rare condition with few cases reported in the veterinary literature. It appears to predominantly affect younger animals 2,4,8–10 although skeletal‐extraskeletal angiomatosis has been reported in an 8‐year‐old dog 14 . The propensity for angiomatosis to affect young animals is consistent with it being a developmental or congenital malformation as is reported in human medicine 15 …”

“…Where possible, complete surgical excision has resulted in remission in multiple case reports 2,4,8,14 . Where complete excision is not possible, alternative treatment options include radiation therapy, metronomic chemotherapy, photocoagulation laser therapy for cutaneous lesions 25,26 or a combination there above 5,9 . Further studies are required to assess for underlying genetic mutations in veterinary patients with angiomatosis and also to optimise treatment regimes.…”

“…1 Angiomatosis is considered to be a nonneoplastic, developmental or congenital malformation affecting blood vessels resulting in multiple tumour-like lesions. In the veterinary literature, angiomatosis has a vast array of presentations and has been reported to affect the skin, 2-5 central nervous system, 6 skeletal muscle, 7 vertebrae [8][9][10][11][12] and gastrointestinal tract. 13 To the authors' knowledge, this is the first case of disseminated peritoneal angiomatosis with arterial differentiation in the dog.…”

Neurological signs and imaging findings in three cats with multiple articular process hypertrophy

“…As seen in case 2, a focal area of intramedullary hyperintensity might be present on T2-weighted MRI, compatible with spinal cord edema secondary to the compression. Important differential diagnoses for APH include hamartomas (Taylor-Brown et al, 2018), angiomatosis (Schur et al, 2010;Hans et al, 2018) and neoplastic processes (Besalti et al, 2016). These differential diagnoses can be differentiated on the basis of histopathological features.…”

“…The clinical signs are mainly related to spinal cord compression, commonly resulting in chronic progressive myelopathy. The main differential diagnosis for APH in cats include angiomatosis (Schur et al, 2010;Hans et al, 2018), intervertebral disc disease (De Decker et al, 2017;Crawford et al, 2018), spinal arachnoid diverticulum (Adams et al, 2015), hamartoma (Taylor-Brown et al, 2018), vertebral malformation (Havlicek et al, 2009), spinal dural ossification (Antila et al, 2013), myelomeningocele (Ricci et al, 2011), neoplastic processes (Besalti et al, 2016) and inflammatory or infectious diseases (Marioni-Henry et al, 2004). Information about APH affecting cats, typical imaging characteristics, treatment and outcome is sparse, with only one recent case report about two cats showing single bilateral APH (T11-T12 in case 1 and T3-T4 in case 2) (Carletti et al, 2019).…”