Rare giant intradural epidural hemolymphangioma: A case report

Abstract

Background: Hemolymphangioma is a rare, noninvasive benign tumor that originates from vascular and lymphatic malformations. It is usually congenital and can present with varying symptoms depending on its location and size. There are very few reports of hemolymphangiomas within the spinal canal, and giant lesions are exceptionally rare.

Case summary: In July 2023, a 64-year-old male with a giant intravertebral epidural hemolymphangioma from thoracic 11 to lumbar 2 (T11-L2) was admitted to the Department of Spine Surgery at the People's Hospital of Binzhou City, China. The patient experienced progressive lumbar and left lower limb pain, numbness, weakness in both lower limbs, and difficulty with urination and defecation. Imaging studies revealed a large cystic mass in the spinal canal at T11-L2. Surgical decompression was performed, and the pathology confirmed hemolymphangioma.

Conclusion: Complete resection of hemolymphangiomas has the best prognosis, and final diagnosis relies on pathologic diagnosis. In this case, the mass was removed intact with a pedicle nail rod system, leading to adequate spinal decompression and restoration of spinal stability.

Keywords: Case report; Hemolymphangioma; Intradural epidural tumor; Surgical treatment; Vascular anomalies; Vascular malformations.

Figure 1

Preoperative imaging data of the patient. A: Magnetic resonance imaging (MRI) sagittal showed a huge intradural mass in the spinal canal at the level of thoracic 11 lumbar 2; B: High signal in the pressure-lipid sequence; C: Low signal in T1WI; D: MRI axial T2WI showed a high signal in the intradural lesion in the spinal canal; E: Frontal X-ray showed lumbar spine degeneration; F: Lateral X-ray showed instability of T12; G: Computed tomography (CT) reconstruction of sagittal position showed enlarged spinal canal, and the pedicles, plates; H: CT transverse section showed enlargement of the spinal canal with thinning of the pedicle and vertebral plate.

Figure 2

Intraoperative resection process of the cyst. A: Remove the posterior wall of the spinal canal to fully reveal the head and tail of the cyst as well as both sides; B: The cyst is huge with a thin outer membrane, tearing the wall of the cyst to release its inner clear fluid to reduce the volume of the cyst; C: Carefully peel off the mass, and its outer membrane is seen to be adhered to the dura mater; D: After complete peeling off of the mass, the dura mater is seen to be well pulsed.

Figure 3

Histopathological analysis of the resected specimen. A: Approximately 70% lymphovascular tissue and 30% vascular tissue at 40 ×; B: Lymphatic venous malformation at 40 ×, manifested by abnormal dilatation, increase, and tortuosity of the vasculature; C: Lymphovascular tissue demonstrated at 100 ×; D: Capillary tissue demonstrated at 100 ×, no abnormal endothelial cell proliferation was seen.

Figure 4

Postoperative imaging. A: Frontal X-ray radiographs showed internal fixation; B: Lateral X-ray radiographs showed the internal fixation; C: Computed tomography (CT) sagittal view showing internal fixation with pedicle root nail rods; D: CT transverse view of the vertebral pedicle in good position.