J Korean Neurosurg Soc.  2015 Jul;58(1):72-75. 10.3340/jkns.2015.58.1.72.

Thoracic Extradural Cavernous Hemangioma Mimicking a Dumbbell-Shaped Tumor

• Jeong WJ
• Choi I
• Seong HY
• Roh SW

• KMID: 2067108
• DOI: http://doi.org/10.3340/jkns.2015.58.1.72

Abstract

Dumbbell-shaped spinal extradural cavernous hemangioma is rare. The differential diagnosis of dumbbell-shaped spinal tumors based on magnetic resonance imaging includes schwannoma and lymphoma. Here, we report a dumbbell-shaped spinal extradural cavernous hemangioma with intrathoracic growth on T2-3 in a 64-year-old man complaining of right side infrascapular area back pain with no neurologic deficit. The cavernous hemangioma was resected through combined video-assisted thoracoscopy and laminectomy without a fusion procedure. The patient had tolerable operative wound pain with no neurologic deficit after surgery. Based on magnetic resonance imaging findings and a review of the literature, we discuss cavernous hemangioma among the differential diagnosis of paravertebral dumbbell-shaped spinal tumors and the importance of complete resection.

Keyword

Hemangioma; Cavernous; Extradural Tumor; Spine

MeSH Terms

Back Pain
Diagnosis, Differential
Hemangioma
Hemangioma, Cavernous*
Humans
Laminectomy
Lymphoma
Magnetic Resonance Imaging
Middle Aged
Neurilemmoma
Neurologic Manifestations
Spine
Thoracoscopy
Wounds and Injuries

Figure

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  Fig. 1 Preoperative T2-weighted sequence (A and B) and T1-weighted sequence (C) magnetic resonance imaging showing an epidural mass compressing the spinal cord along the T2-3 disc level. The epidural mass revealed iso-signal intensity on T1-weight sequence and high signal intensity on T2-weighted sequence. Preoperative magnetic resonance imaging showed well-demarcated round-shaped abnormal high signal intensity with mottled low signal intensity on both T1- and T2-weighted sequences within the left half of the T2 vertebral body extending to the left pedicle.

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  Fig. 2 Intraoperative microscopic photography. Laminectomy was performed from T2 to T4. A pinkish, non-encapsulated mass (white arrow) was found, which was attached to the dura mater and extended through the left T2-3 intervertebral foramen.

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  Fig. 3 High-magnification (×40) of a haematoxylin and eosin (H&E) stained section showing the cavernous hemangioma composed of an irregular cavernous vascular space. Some of the vascular spaces contained blood. The walls of the vascular space were lined by a single layer of endothelium.

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  Fig. 4 Postoperative day 1 magnetic resonance images of the patient. T2-weighted sequence (A and B) and T1-weighted sequence (C) images showing no residual extradural cavernous hemangioma. However, the T2 vertebral body cavernous hemagioma was still present.

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