Thoracic Extradural Cavernous Hemangioma Mimicking a Dumbbell-Shaped Tumor

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.

A Dumbbell-Shaped Extradural Intracanal Cavernous Hemangioma: A Rare Case Report and Review of Literature

“…On histologic examination, the mass is sharply defined but not encapsulated and is composed of large, cavernous blood-filled vascular spaces, separated by connective tissue stroma [2][3][4][5][6][7]. Cavernous hemangiomas detected by imaging studies may be difficult to distinguish from their malignant counterparts, but with the magnetic resonance imaging (MRI), the lesion is more frequently diagnosed than we previously considered [1][2][3][4][5][6][7]. Brain hemangiomas are also problematic, as they can cause symptoms related to compression of adjacent tissue or rupture.…”

“…Cavernous hemangioma can be found in any part of CNS axis [1,5,7]; some parts more often that others. They can be found in epidural or extradural, spinal or cranial and thoracic or lumbar [1][2][3]7].…”

“…10-27% of adults suffer from spinal hemangiomas, therefore they are unexpectedly common. 'Four'% of all spinal epidural lesions are cavernous hemangiomas so evidently they are considered rare problems [3,5,7]. Spinal Cavernous hemangiomas are more common in women (70%) than in men, and the average age is 40 [3,4,7].…”

“…Evidently, the most reported cases are intracranial and supratentorial [3]. Also Spinal Cavernous Hemangiomas commonly occur in vertebral body extradurally and in some cases extend to spinal canal, which consist of only 'five'-12% of spinal vascular problems [1][2][3][4][5][6][7]. Here we report one of our rare experiences in spinal surgery with dumbbell-shaped cavernous hemangioma extended from intervertebral foramen and left its great part in the canal.…”

“…They can be located anywhere in the neural axis as well as other part of the body like liver and eyes [3][4][5][6]. Evidently, the most reported cases are intracranial and supratentorial [3].…”