Iida Shunpei, Kobayashi Fumiaki, Kawano Ryutaro, Saita Kazuo, Ogihara Satoshi
Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
Radiol Case Rep. 2021 Feb 11;16(4):938-941. doi: 10.1016/j.radcr.2021.01.060. eCollection 2021 Apr.
Vertebral hemangiomas are common benign tumors that are mostly asymptomatic and are discovered incidentally. Only 0.9-1.2% of all vertebral hemangiomas, termed aggressive vertebral hemangiomas, expand to cause pain and neural compression. We present an extremely rare case of a 49-year-old woman who had an aggressive vertebral hemangioma of the thoracic spine that caused rapidly progressive myelopathy with remarkable irregular extraosseous bone proliferation, which mimicked a malignant vertebral tumor. In this case, despite the lesion's hostile appearance during imaging, the pathological diagnosis was benign and symptom-based surgical treatment with posterior decompression and stabilization provided good clinical outcomes during the postoperative 18 months follow-up period. In this case, despite the use of standard imaging modalities (radiograph, CT, and MRI), making a preoperative imaging diagnosis of an aggressive vertebral hemangioma was difficult, and although aggressive vertebral hemangiomas with atypical radiological features are rare, they should be considered as a differential diagnosis.
椎体血管瘤是常见的良性肿瘤，大多无症状，多为偶然发现。在所有椎体血管瘤中，只有0.9%-1.2%的被称为侵袭性椎体血管瘤，会扩大并导致疼痛和神经受压。我们报告了一例极其罕见的病例，一名49岁女性患有胸椎侵袭性椎体血管瘤，导致快速进展性脊髓病，并伴有明显的不规则椎体外骨质增生，酷似恶性椎体肿瘤。在该病例中，尽管病变在影像学上表现凶险，但病理诊断为良性，基于症状的手术治疗采用后路减压和稳定术，在术后18个月的随访期内取得了良好的临床效果。在该病例中，尽管使用了标准的影像学检查方法（X线片、CT和MRI），术前对侵袭性椎体血管瘤进行影像学诊断仍很困难，虽然具有非典型放射学特征的侵袭性椎体血管瘤很少见，但应将其作为鉴别诊断考虑。
