title: Lumbar hemangioma masking a plasma cell tumor--case report and review of the literature.
abstract: BACKGROUND
  Vertebral hemangiomata are ubiquitous bone tumors. Often multiple, they are generally benign in nature and slow growing. They typically have a predictable radiographic appearance. Occasionally, hemangiomata may behave in a more aggressive manner, causing pathologic fracture or even symptoms/signs of nerve compression. In such cases, one must be careful not to assume that an atypical hemangioma is responsible. Coexisting, more malignant processes may be present and sometimes may be radiographically undetectable in the setting of acute fracture. This was the case in our patient.
  
  
  METHODS
  Case report/university spine surgery center.
  
  
  METHODS
  The patient underwent a corpectomy of her affected vertebra with conversion to a total spondylectomy when intraoperative frozen section was consistent with plasma cell neoplasm. A reconstruction with vertebral body replacement and fusion through anterior and posterior approaches was completed. Subsequently, the literature was reviewed for other cases of atypical hemangiomata to investigate the incidence of coexistent lesions.
  
  
  RESULTS
  This patient presented with pain secondary to an unstable pathologic vertebral body fracture. Surgery to stabilize her spine was elected. Intraoperative recognition of abnormal-appearing tissue led to the diagnosis of a plasma cell neoplasm that was not seen on imaging. Coexistent in the same vertebra was hemangiomatous tissue that was visible on preoperative imaging.
  
  
  CONCLUSIONS
  There are rare reports of aggressively behaving hemangiomata that mainly have occurred in the thoracic spine. There have been no reports of the coexistence of a hemangioma and a plasma cell tumor in the same vertebral level in the setting of acute compression fracture.
authors.affiliation: Department of Orthopaedic Surgery, UMDNJ-Robert Wood Johnson Medical School, 51 French St, MEB 422A, New Brunswick, NJ 08901, USA. maahirhaque@gmail.com
authors.forename: Maahir U
authors.initials: MU
authors.lastname: Haque
authors.forename: Adam N
authors.initials: AN
authors.lastname: Wilson
authors.forename: Haim D
authors.initials: HD
authors.lastname: Blecher
authors.forename: Steven M
authors.initials: SM
authors.lastname: Reich
mesh_terms: D005260:Female; D006391:Hemangioma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D010954:Plasmacytoma / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Hemangioma; Pathologic vertebral body fracture; Plasma cell tumor; Spine tumor surgical technique