Intradural extramedullary capillary hemangioma of lower thoracic spinal cord

Abstract

Capillary hemangiomas are benign tumors and tumor like conditions commonly involving skin and mucus membrane of head and neck region. They are extremely rare in the spinal cord. We report a 35-year-old male presenting with gradual progressive paraparesis over a period of 4 months. Magnetic resonance imaging showed a hypo- to isointense intradural mass at the level of D12 vertebral body on T1-weighted images and homogenous enhancement on gadolinium contrast. Complete surgical resection revealed intradural extramedullary tumor, which on histopathologic examination showed characteristics of capillary hemangioma. At 1.5 years followup patient was asymptomatic.

Spinal capillary hemangiomas: Two cases reports and review of the literature

“…Within the spine, this tumor is commonly found in the vertebral bodies[ 1 ] but only a few cases of intradural capillary hemangioma have been reported [ Table 1 ]. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 ] The tumor's characteristics are common in males, located at the thoraco-lumbar level, and clustered in the forth to sixth decades of life [ Table 2 ]. Thus, based on case series of 64 patients, authors propose a classification scheme for the spinal capillary hemangioma classification into five types [ Figure 5 ].…”

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

“…Intradural spinal, extramedullary, cavernous hemangiomas are most frequently found in the adult population (only 4 pediatric cases cited in literature), mostly in women (23), in the thoracic spine -80% of cases (9)(12) or lower thoraco-lumbar region (13) (20), with posterior location within the spinal canal in 93% of cases; also with possible lateral recesses extensions; less common in cervical location (7)(8) and mostly adherent to the nerve root or spinal cord (8) (24). Capillary hemangiomas are found in the skin and soft tissues in younger people, and rarely occur in the central nervous system; more frequent they are located around or attached to nerve roots of cauda equina and conus medullaris (25), extremely rarely intradurally (16) 16,25) Clinical symptomatology at presentation is variable, depending on the size and topography, with the more frequent symptoms beeing: acute spinal pain, radiculopathy and/or myelopathy, progressive gait disturbance, slowly progressive paraparesis, or even asymptomatic -very rare, as in our case (5,18,(26)(27)(28). Cavernous hemangiomas may present in four major clinical patterns: acute episodes of step wise deterioration, slow progression, acute onset with rapid deterioration, and acute onset with gradual decline (10,12,14,15,18).…”

“…-complete lack of enhancement in case of sclero-hyaline degeneration Features of capillary hemangioma on MR images are: isointense lesion on T1-weighted images, hyperintense relative to the spinal cord on T2-weighted images, and homogenous, strong enhancement on contrast-enhanced T1-weighted images (9,25,40,41), and also the presence of enlarged draining perimedullary veins (9).…”

Cervical Capillary Haemangioma: A Case Report

“…2 Even after total excision during surgery, symptoms remained in 25% of cases. 1 The investigation of choice is MR imaging. 5 In MR images, the tumor showed isointensity relative to the spinal cord because of the slow blood flow on T1-weighted images and hyperintensity on T2-weighted images because of the high content of stagnant blood.…”