Intradural extramedullary capillary hemangioma

Case contributed by Michael Burns
Diagnosis certain


Difficulty in walking, progressing over 2 months

Patient Data

Age: 70 years
Gender: Female

There is prominent central cord T2 weighted hyperintensity extending from the T1 level to the conus, situated at T12-L1. This is thought to represent cord edema rather than a syrinx.

At T9 level, there is a well-circumscribed lesion in the left/posterior thecal sac adjacent to the cord, extending as far as the dura. The thecal sac appears mildly expanded posteriorly and effaced anteriorly on sagittal imaging. Location is favored to be intradural extramedullary.

The lesion is T1 weighted hyperintense and avidly enhances. It measures 12 mm transverse, 9 mm AP, and 16 mm craniocaudal diameter.

In retrospect, it can be identified on the previous chest CT as an ill-defined area of enhancement. No adjacent bony remodeling. No other abnormal enhancing lesion is present. No flow voids, adjacent abnormal vessels, or cord expansion were seen to suggest a dural arteriovenous fistula (AVF).  


Pathology report

T9 spinal cord tumor, resection:
Final diagmosis - Benign vascular tumor consistent with a benign hemangioma.
- Please see microscopic description.


H&E stained sections show a vascular lesion composed of abundant endothelial cells and small vascular spaces as well as larger pooled areas of blood. Some of the vessels are hyalinized. The endothelial cells show little pleomorphism. Mitoses are infrequent.

Immunostaining with CD34, pancytokeratin, Ki-67, CD20 and CD3 is performed on Block A1. CD34 is diffusely and strongly positive throughout the tumor, thereby confirming the
endothelial origin of these cells and highlighting the small vascular spaces. Ki-67 stains
nuclei that are most likely inflammatory cells within blood vessels rather than
endothelial cells. CD20 staining is largely negative. CD3 stains T-cells that are
predominantly at the periphery of the lesion.

In summary, the morphologic characteristics and immunohistochemical staining pattern of
this lesion is most consistent with a benign capillary hemangioma, a benign vascular

Case Discussion

Capillary hemangiomas are benign tumors frequently found in the skin and soft tissues. They have been rarely reported in the intradural extramedullary space.

Differential includes meningioma, schwannoma, or leptomeningeal metastasis.

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