Spinal collision lesions

Abstract

Collision lesions are rare neoplasms often described in the hepatobiliary system, genitourinary system and adrenal glands. Vertebral haemangiomas (VH) are the most common lesions involving the vertebral bodies. VHs are usually asymptomatic and considered as "Do not touch" lesions. Rarely they can be symptomatic. Imaging findings of typical and atypical haemangiomas, variant forms of haemangioma such as aggressive haemangiomas are well known. Collision lesions involving VHs are extremely rare. This article presents a series of cases with collision lesions of the vertebral body involving VHs. Advances in knowledge: This Case series demonstrates the various collision lesions in spinal haemangioma.

A 68-Year-Old Woman with a Remote History of Breast Cancer Presenting with Low Back Pain to a Chiropractic Clinic in Hong Kong with Imaging Findings Consistent with a Vertebral Hemangioma and Vertebral Metastatic Lesions

“…The thickened vertical vertebral trabecular pattern is suggestive of VH but is not necessarily conclusive. As illustrated in this case and prior collision tumor cases [ 7 , 8 , 29 , 30 ], there rarely may be underlying malignancy that is only evident with advanced imaging. On MRI, VHs are typically hyperintense on both T1-weighted and T2-weighted images [ 8 ].…”

“…As illustrated in this case and prior collision tumor cases [ 7 , 8 , 29 , 30 ], there rarely may be underlying malignancy that is only evident with advanced imaging. On MRI, VHs are typically hyperintense on both T1-weighted and T2-weighted images [ 8 ]. In contrast, vertebral metastasis is hypointense on T1 and hyperintense on T2-weighted images [ 8 ].…”

“…Clinicians managing spinal disorders, such as chiropractors, should be aware that degenerative spinal changes are common and can be asymptomatic [ 19 ]. VHs are typically asymptomatic, except for rare instances of atypical or aggressive VH [ 8 ]. Additionally, in patients with spinal metastasis, the onset of neurological deficits may take months, which can further contribute to diagnostic delay [ 2 ].…”

“…On MRI, VHs are typically hyperintense on both T1-weighted and T2-weighted images [ 8 ]. In contrast, vertebral metastasis is hypointense on T1 and hyperintense on T2-weighted images [ 8 ]. Although increased fluorodeoxyglucose uptake on PET/CT is typically associated with metastasis [ 13 , 14 ], this can also occur with VH [ 6 ].…”

“…Occasionally VHs are atypical or aggressive, and mimic the appearance of metastasis [ 6 ]. Even more rarely, cancer can metastasize into a pre-existing hemangioma, which is termed a collision tumor [ 7 , 8 ].…”