Two cases of hemolymphangioma in the thoracic spinal canal and spinal epidural space on MRI: The first report in the literature

Abstract

Rationale: Hemolymphangioma is a rare, noninvasive benign tumor of mesenchymal origin resulting from malformation of vascular and lymphatic vessels. The incidence of hemolymphangioma in the spinal canal is low.

Patient concerns: This report describes 2 patients with a lesion located in the thoracic spinal canal or spinal epidural space, who were misdiagnosed with suspected meningioma or suspected schwannoma, respectively, based on magnetic resonance imaging (MRI).

Diagnoses: Hemolymphangioma.

Interventions: The application of a surgery was designed to treat the 2 patients.

Outcomes: 2 patients stated that symptoms were improved after the operation.

Lessons: This report should raise awareness among clinicians that careful image analysis and consideration of patient history and pathology is required for accurate differential diagnosis of hemolymphangioma in the spinal canal and spinal epidural space.

Figure 1

Case 1: A–C Sagittal magnetic resonance imaging (MRI) showing a lesion located in the spinal canal. The lesion appears hyperintense on T1-weighted images (A); the lesion appears hypointense and hyperintense on T2-weighted and fat suppression images (B, C); D, E: Contrast enhanced sagittal and coronal MRI showing an uneven, slightly enhanced shadow; F: pathology showing a thrombus (H&E ×10).

Figure 2

Case 2: A–C: Sagittal magnetic resonance imaging (MRI) showing a lesion located in the spinal canal. The lesion appears hypointense on T1-weighted images (A); the lesion appears hyperintense on T2-weighted and fat suppression images (B, C); D, E: Contrast enhanced the lesion showed irregular, severe enhanced shadow in the spinal epidural space at T10 to T12 and intervertebral perforation at T10/11. F: Pathology showing a hemangioma on the left and a lymphangioma on the right (H&E ×10).