Unnithan Ajaya Kumar Ayyappan, Joseph T P, Gautam Amol, Shymole V
Mar Gregorios Memorial Muthoot Medical Centre, Kozhencherry, Kerala, India.
Surg Neurol Int. 2016 Mar 2;7(Suppl 5):S139-41. doi: 10.4103/2152-7806.177886. eCollection 2016.
Capillary hemangioma is a rare tumor in spinal intradural location. Despite the rarity, early recognition is important because of the risk of hemorrhage. This is a case report of a woman who had capillary hemangioma of cauda equina.
A 54 -year-old woman presented with a low backache, radiating to the left leg for 2 months. She had left extensor hallucis weakness, sensory impairment in left L5 dermatome, and mild tenderness in lower lumbar spine. Magnetic resonance imaging (MRI) LS spine showed L4/5 intradural tumor, completely occluding canal in myelogram, enhancing with contrast, s/o benign nerve sheath tumor. L4 laminectomy was done. Reddish tumor was seen originating from a single root. It was removed preserving the root. Postoperatively, she was relieved of symptoms. MRI showed no residue. Histopathology showed lobular proliferation of capillary-sized blood vessels and elongated spindle cells. Immunohistochemistry showed CD34 positivity in endothelial cell lining of blood vessel and smooth muscle actin positivity in blood vessel muscle cells. HPR-capillary hemangioma.
Although rare, capillary hemangioma should be in the differential diagnosis of intradural tumors. It closely mimics nerve sheath tumor.
毛细血管瘤是一种罕见的脊髓硬膜内肿瘤。尽管罕见，但由于存在出血风险，早期识别很重要。本文报告一例马尾毛细血管瘤女性患者。
一名54岁女性，腰痛伴向左下肢放射痛2个月。左足背伸肌无力，左侧L5皮节感觉障碍，下腰椎轻度压痛。腰椎磁共振成像（MRI）显示L4/5硬膜内肿瘤，脊髓造影显示肿瘤完全阻塞椎管，增强扫描有强化，考虑为良性神经鞘瘤。行L4椎板切除术。可见一红色肿瘤起源于单一神经根。保留神经根将肿瘤切除。术后患者症状缓解。MRI显示无残留。组织病理学显示毛细血管大小的血管呈小叶状增生，有细长的梭形细胞。免疫组化显示血管内皮细胞衬里CD34阳性，血管肌细胞平滑肌肌动蛋白阳性。病理诊断为毛细血管瘤。
尽管罕见，但毛细血管瘤应列入硬膜内肿瘤的鉴别诊断。它与神经鞘瘤极为相似。
