Aggressive vertebral hemangioma

Case contributed by Dr Henry Knipe

Presentation

Lower limb pain and weakness.

Patient Data

Age: 30 years
Gender: Male

The T4 vertebral body lesion, the extraosseous extradural intraspinal, left foraminal and left fourth rib lobulated mass. The cord is displaced to the right. There is no change to the degree of distortion and no definite signal changes seen within the cord at the compression level.

No loss of vertebral body height. No other significant lesion seen noting the incidental T11 lesion likely to be a hemangioma, unchanged.

The patient went on to biopsy / debulking. 

HISTOPATHOLOGY

MACROSCOPIC DESCRIPTION: Multiple fragments of pale tan firm tissue measuring in aggregate 25x20x3mm.

MICROSCOPIC DESCRIPTION: The sections show fragments of viable bone, ligament and soft tissue. Adjacent to several bone fragments are collapsed vascular spaces. These are lined by unremarkable endothelial cells. The walls of these channels are composed of loose fibrous tissue. There is some bone remodeling evident. The features are of haemangiom of bone. No evidence of malignancy is seen.

DIAGNOSIS: Hemangioma of bone.

Case Discussion

Most vertebral hemangiomas are benign lesions. Occassionaly they can be locally aggressive with extravertebral extension. They become symptomatic by causing nerve root / spinal cord compression. 

75% of these lesions occur in the thoracic spine between T3-T9. Accurate preoperative diagnosis is essential because they are highly vascular. 

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