Spinal cord compression through extraosseous extension of a vertebral low-grade hemangioendothelioma with histiocytoid differentiation.
Herein, we report the case of a 47-year-old man clinically presenting a slow progressive loss of lower extremity functions within 8 weeks followed by an acute neurogenic bladder dysfunction. The patient exhibited high-grade paralysis of both legs with reduced sensation from dermatome Th11 downwards as well as marked spasticity of the lower extremity. Neuroradiological examinations revealed a protruding spinal tumor with extraosseous-intraspinal extension. The resected tumor mass exhibited a highly vascularized tumor with architectural complexity and high cellularity finally leading to the diagnosis of a hemangioendothelioma. Interesting was the fact that the tumor vasculature exhibited many CD68-positive cells protruding into the lumen and, therefore, being part of a partially histiocytoid differentiation which is all the more uncommon in hemangioendothelioma. The time frame of 3 hours between embolization and tumor resection is too short to explain a monocytic intravascular reaction. Usually, hemangioendotheliomas arise from the soft tissue, lungs or liver, but intraspinal manifestations are only rarely observed. Furthermore, the clinical course with a progressive development of a paraparesis due to a hemangioendothelioma is very uncommon.
Mittelbronn
M
M
Institute of Brain Research, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. hirnforschung@uni-tuebingen.de
Schittenhelm
J
J
Ritz
R
R
Hahn
U
U
Bornemann
A
A
Roser
F
F
D000437:Alcoholism / Q000150:complications; D015901:Angiography, Digital Subtraction; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D006390:Hemangioendothelioma / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D013904:Thoracic Vertebrae / Q000473:pathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C067980:CD68 antigen, human; D000097382:CD68 Molecule