Thoracic spine hemangioma causing rapidly progressive myelopathy and mimicking a malignant tumor: A case report

Abstract

Vertebral hemangiomas are common benign tumors that are mostly asymptomatic and are discovered incidentally. Only 0.9-1.2% of all vertebral hemangiomas, termed aggressive vertebral hemangiomas, expand to cause pain and neural compression. We present an extremely rare case of a 49-year-old woman who had an aggressive vertebral hemangioma of the thoracic spine that caused rapidly progressive myelopathy with remarkable irregular extraosseous bone proliferation, which mimicked a malignant vertebral tumor. In this case, despite the lesion's hostile appearance during imaging, the pathological diagnosis was benign and symptom-based surgical treatment with posterior decompression and stabilization provided good clinical outcomes during the postoperative 18 months follow-up period. In this case, despite the use of standard imaging modalities (radiograph, CT, and MRI), making a preoperative imaging diagnosis of an aggressive vertebral hemangioma was difficult, and although aggressive vertebral hemangiomas with atypical radiological features are rare, they should be considered as a differential diagnosis.

Keywords: Extraosseous; Hemangioma; Myelopathy; Spine; Tumor; Vertebral.

Fig. 1

(A). Preoperative anterior-posterior radiograph shows a compressive deformity of the T10 vertebra (arrow) with obscurity of the shape of the right pedicle. (B). Preoperative lateral radiograph shows the T10 vertebral column (arrow) with heterogeneous sclerosis.

Fig. 2

(A). Preoperative right-sagittal T1-weighted magnetic resonance (MR) image shows the T10 vertebral tumor with a low signal intensity. (B). Preoperative right-sagittal T2-weighted MR image shows the T10 vertebral tumor with a moderately heterogeneous high signal intensity. (C). Preoperative right-sagittal gadolinium-enhanced fat-suppressed MR image shows the T10 vertebral tumor with a moderately heterogeneous high signal intensity. (D). Preoperative axial gadolinium-enhanced fat-suppressed MR image shows extraosseous tumoral extensions causing spinal cord compression with enlargement of the right transverse process and pedicle. (E) Preoperative coronal computed tomography (CT) image of the T10 vertebra shows heterogeneous sclerosis and remarkable extraosseous bone proliferation on the right side. (F). Preoperative axial CT image of the T10 vertebra shows marked irregular extraosseous bone formations predominantly on the right side.

Fig. 3

(A). Postoperative anterior-posterior radiograph of the spine. (B). Postoperative lateral radiograph of the spine.

Fig. 4

Histopathological study of the resected specimen from the right side of the T10 lamina shows congestion of capillary vessels without anastomosis, consistent with osseous capillary hemangioma (hematoxylin and eosin staining, × 100).

Fig. 5

Axial computed tomography image of the T10 vertebra at 12 months postoperatively shows sustained decompression of the spinal canal.