Treatment of lumbar vertebra epithelioid hemangioma with radiation therapy: a case report

Abstract

Background Although epithelioid hemangiomas involving bone have been described in previous case reports and case series, the effects of radiation therapy on vertebral epithelioid hemangioma has not been fully reported. Here we provide a case report of tumor response to radiation therapy in a young adult with a large epithelioid hemangioma involving the fourth lumbar vertebrae. Case presentation A 27-year-old Latino man with a past medical history of type 1 diabetes and a 3-year history of low back pain presented to a hospital emergency department following acute worsening of back pain. On transfer to our tertiary medical center, he described the pain as “shock-like” which originated at the lateral aspect of his right hip and radiated down to his right knee. Paresthesia was also reported along the medial aspect of his lower right leg. Imaging included a computed tomography scan and magnetic resonance imaging which revealed fourth lumbar and right iliac lytic bone lesions. Image-guided biopsies of the lytic lesions were consistent with a diagnosis of epithelioid hemangioma and radiation therapy was recommended as the primary treatment. Our patient’s low back and leg pain were initially managed with acetaminophen, oxycodone, pregabalin, and lidocaine patch 5%. He noted improvement in pain after his third fraction of radiation. Pain intensity continued to decline and oxycodone was discontinued. Conclusions This case report demonstrates an unusual etiology of back and leg pain in a young man and elucidates the palliative effects of radiation therapy for epithelioid hemangioma involving the lumbar spine.

Nội Mô Mạch Máu Dạng Biểu Mô Của Xương Cột Sống: Báo Cáo Nhân Một Trường Hợp

“…-Điều trị: Chưa có hướng dẫn điều trị tiêu chuẩn của EHE cột sống do tỷ lệ hiếm gặp và diễn biến lâm sàng đa dạng. Các phương pháp điều trị EHE cột sống là phẫu thuật, xạ trị, hóa chất [4], [5], [6], [8]. Hiệu quả điều trị còn nhiều tranh cãi, cần đánh giá toàn bộ trước khi điều trị.…”

A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass

“…Bones involved are long tubular bones (around 40%), short tubular bones (more commonly feet), flat bones, and, rarely, vertebrae [ 3 ]. We could only find a handful of related case reports [ 2 , 5 , 6 ]. In the spine, EH can cause pain, instability, and/or neurologic dysfunction.…”