title: Rare angioproliferative tumors mimicking aggressive spinal hemangioma with epidural expansion.
abstract: OBJECTIVE
  We present two cases of angio-proliferative tumors that were misdiagnosed and treated as typical hemangiomas with epidural expansion.
  
  
  METHODS
  Two middle-aged women presented with symptoms and radiological signs characteristic for aggressive hemangioma with epidural expansion. In the first case preoperative embolization and decompressive surgery with open transpedicular vertebroplasty was performed. Within less than a year, epidural recurrence of the tumor prompted for radical excision and corpectomy. The diagnosis after the histological studies and the further clinical evolution was metastasizing leiomyomatosis. No further recurrence occured during the next 6 years. In the second case percutaneous vertebroplasty was performed and complicated by epidural polymethyl-methacrylcate (PMMA) leakage, requiring urgent decompressive surgery. Histological study of the lesion raised the possibility of myopericytoma. This was confirmed 16 months later when complete vertebrectomy was performed due to severe epidural propagation of the recurring tumor. No further recurrence occurred in next the two years.
  
  
  CONCLUSIONS
  Rare angio-proliferative tumors, like benign metastasizing leiomyoma and myopericytoma radiologically may resemble aggressive vertebral hemangiomas of the spine. Unlike hemangiomas, such tumors require radical removal due to their likely recurrence. As imaging studies may not be able to completely exclude such pathologies, bone biopsy and thorough histopathological studies are warranted prior to the therapeutic decision.
authors.affiliation: National Institute of Neurosciences, Budapest. kulcsarzsolt22@gmail.com
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Kulcsár
authors.forename: Róbert
authors.initials: R
authors.lastname: Veres
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Hanzély
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Berentei
authors.forename: Miklós
authors.initials: M
authors.lastname: Marosfoi
authors.forename: István
authors.initials: I
authors.lastname: Nyáry
authors.forename: István
authors.initials: I
authors.lastname: Szikora
mesh_terms: D001843:Bone Cements / Q000627:therapeutic use; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D004630:Emergencies; D015174:Epidural Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D005260:Female; D006391:Hemangioma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D020286:Pericytes; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate