Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Department of Minimally Invasive Brain and Spine Surgery, Sri Ramakrishna Hospitals, Coimbatore, India.
World Neurosurg. 2019 Oct;130:479-483. doi: 10.1016/j.wneu.2019.06.172. Epub 2019 Jul 8.
Vascular tumors of the spine range from benign hemangiomas to malignant angiosarcomas. Hemangioendotheliomas of spine are tumors of intermediate-grade malignancy with rare occurrence in the intradural location. The imaging and histopathologic features may mimic other common lesions occurring at this location.
A 70-year-old woman presented with lower limb weakness and sensory impairment along the L5-S1 dermatome. A radiologic diagnosis of neurofibroma at the intradural location of the L4-L5 level was made, and total excision of the space-occupying lesion was done. Histopathologic examination, however, revealed a vascular tumor consistent with hemangioendothelioma, which was confirmed by immunohistochemical analysis. We present this case discussing the dilemmas and difficulties in arriving at the diagnosis, highlighting the role of immunohistochemical aid.
Histomorphology, aided by ancillar tests like immunohistochemistry, remains the criterion for the definitive diagnosis of such rare lesions, and pathologists need to be aware of these lesions occurring in uncommon locations.
脊柱血管肿瘤的范围从良性血管瘤到恶性血管肉瘤。脊柱的血管内皮细胞瘤是一种中度恶性肿瘤，在硬脊膜内位置罕见。其影像学和组织病理学特征可能与其他常见病变类似，这些病变也发生在该位置。
一名 70 岁女性因下肢无力和感觉障碍沿着 L5-S1 皮节出现而就诊。放射学诊断为 L4-L5 水平硬脊膜内的神经纤维瘤，并进行了占位病变的全切除。然而，组织病理学检查显示符合血管内皮细胞瘤的血管肿瘤，免疫组织化学分析证实了这一点。我们提出这个病例，讨论了诊断中的困境和困难，强调了免疫组织化学辅助的作用。
组织形态学，辅助以免疫组织化学等辅助测试，仍然是这些罕见病变的明确诊断标准，病理学家需要意识到这些病变发生在不常见的位置。
