Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, United States.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States.
Global Spine J. 2015 Apr;5(2):135-9. doi: 10.1055/s-0034-1387198. Epub 2014 Aug 5.
Study Design Case report. Objective Multifocal epithelioid hemangioendothelioma (EHE) of the spine is a rare disorder. We describe a novel, multimodal treatment of a painful osteolytic lumbar lesion secondary to EHE. The minimally invasive treatment results in an excellent patient outcome with decreased morbidity compared to traditional techniques. Methods A previously healthy young adult presented with a painful osteolytic lesion at the L2 vertebrae. Imaging revealed multifocal spinal lesions consistent with a history of EHE. Core needle biopsy confirmed the diagnosis. Preoperative cryoablation of L2 was followed by a staged surgery, which included a partial L2 corpectomy, tumor resection, bone grafting, and vertebral reconstruction using a minimally invasive technique. This treatment was followed by prolonged therapy with interferon and bisphosphonate. Results At 3.5 years' follow-up, the patient has maintained his vertebral body height, has not required a fusion, and has had no recurrence of disease. Conclusion Multimodal treatment consisting of tumor cryoablation, partial corpectomy, allograft reconstruction of the vertebrae, and adjuvant interferon and bisphosphonate can result in good outcomes for well-contained EHE tumors of the spine.
研究设计 病例报告。目的 脊柱多灶性上皮样血管内皮细胞瘤（EHE）是一种罕见疾病。我们描述了一种新的、多模式的治疗方法，用于治疗继发于 EHE 的疼痛性溶骨性腰椎病变。与传统技术相比，这种微创治疗可获得极好的患者结局，并降低发病率。方法 一位既往健康的年轻成年人因 L2 椎体溶骨性疼痛性病变就诊。影像学显示多灶性脊柱病变，与 EHE 病史一致。经皮穿刺活检证实了诊断。L2 冷冻消融术的术前治疗后，进行了分期手术，包括部分 L2 椎体切除术、肿瘤切除术、植骨术以及使用微创技术进行的椎体重建。随后进行了干扰素和双膦酸盐的长期治疗。结果 在 3.5 年的随访中，患者保持了椎体高度，未行融合，且疾病无复发。结论 由肿瘤冷冻消融术、部分椎体切除术、同种异体骨重建椎体以及辅助干扰素和双膦酸盐组成的多模式治疗方法，可使脊柱 EHE 肿瘤得到良好的控制。
