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Hemophilic pseudotumor of the first lumbar vertebra.

Nachimuthu G, Arockiaraj J, Krishnan V, Sundararaj GD - Indian J Orthop (2014)

Bottom Line: Excision of pseudotumor was successfully carried out with additional spinal stabilization.At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status.Surgical excision gives satisfactory outcome in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT
Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases.

No MeSH data available.


Related in: MedlinePlus

Photomicrographs showing inflammatory granulation tissue with hemosiderophages and evidence of old hemorrhages (×200)
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Figure 5: Photomicrographs showing inflammatory granulation tissue with hemosiderophages and evidence of old hemorrhages (×200)

Mentions: Macroscopic examination revealed a large oblong mass measuring 20 × 8.5 × 6 cm mass with irregular bosseleated outer surface with large dilated veins over the same. The margins (except the superior margin) were smooth and well defined. It had variable consistency. “Chocolate like” material (due to blood clots) was found on the cut section of the mass. Multiloculated cysts containing blood clots were noted. The largest cyst being 11 cm in the maximum diameter with a thickness of 0.7 cm. Microscopic examination revealed that the cyst wall was composed of extensively hyalinized fibrous tissue lined on one aspect by inflammatory granulation tissue with numerous hemosiderophages. The wall revealed mild chronic inflammation and areas of old hemorrhage confirming a diagnosis of hemophilic pseudotumor [Figure 5].


Hemophilic pseudotumor of the first lumbar vertebra.

Nachimuthu G, Arockiaraj J, Krishnan V, Sundararaj GD - Indian J Orthop (2014)

Photomicrographs showing inflammatory granulation tissue with hemosiderophages and evidence of old hemorrhages (×200)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232833&req=5

Figure 5: Photomicrographs showing inflammatory granulation tissue with hemosiderophages and evidence of old hemorrhages (×200)
Mentions: Macroscopic examination revealed a large oblong mass measuring 20 × 8.5 × 6 cm mass with irregular bosseleated outer surface with large dilated veins over the same. The margins (except the superior margin) were smooth and well defined. It had variable consistency. “Chocolate like” material (due to blood clots) was found on the cut section of the mass. Multiloculated cysts containing blood clots were noted. The largest cyst being 11 cm in the maximum diameter with a thickness of 0.7 cm. Microscopic examination revealed that the cyst wall was composed of extensively hyalinized fibrous tissue lined on one aspect by inflammatory granulation tissue with numerous hemosiderophages. The wall revealed mild chronic inflammation and areas of old hemorrhage confirming a diagnosis of hemophilic pseudotumor [Figure 5].

Bottom Line: Excision of pseudotumor was successfully carried out with additional spinal stabilization.At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status.Surgical excision gives satisfactory outcome in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT
Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases.

No MeSH data available.


Related in: MedlinePlus