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A case of dumbbell-shaped epidural cavernous angioma in the lumbar spine.

Yunoki M, Suzuki K, Uneda A, Yoshino K - Surg Neurol Int (2015)

Bottom Line: A 77-year-old female presented with a one-year history of lumbago and right-sided L3 dermatomal hypoesthesia.A dumbbell mass at the L2/3 vertebral level was identified on lumbar MRI.A presumptive diagnosis was schwannoma, but other malignant neoplasms were also considered because of its irregular shape, minimally dilated neural foramen and the involvement of the non-enhanced L3 nerve root.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan.

ABSTRACT

Background: Most spinal cavernous haemangiomas occur in the vertebral body and purely extradural cavernous hemangiomas without any vertebral body involvement is rare and account for only 4% of all extradural spinal tumors. Dumbbell-shaped spinal cavernous angioma is extremely rare, only 10 cases have been reported in the literature.

Case description: A 77-year-old female presented with a one-year history of lumbago and right-sided L3 dermatomal hypoesthesia. A dumbbell mass at the L2/3 vertebral level was identified on lumbar MRI. The lesion was irregularly shaped and isointense on T1W and hyperintense on T2W and DWI images with homogenous contrast enhancement. A presumptive diagnosis was schwannoma, but other malignant neoplasms were also considered because of its irregular shape, minimally dilated neural foramen and the involvement of the non-enhanced L3 nerve root. The patient underwent surgery with a lateral extracavitary approach. A histopathological examination revealed cavernous hemangioma.

Conclusion: Cavernous hemangioma should be included in the differential diagnosis of dumbbell-shaped spinal tumors when the intervertebral foramina is not highly dilated and non-enhanced nerve root is identified in the tumor.

No MeSH data available.


Related in: MedlinePlus

(a) A transverse computed tomography (CT) scan at the level of L2/3 showing a left-sided dumbbell-shaped mass (thick arrow). The posterior wall of the right intervertebral foramen was slightly eroded (thin arrow). (b) A coronal CT scan demonstrating the mildly enlarged right intervertebral foramen and dumbbell-shaped mass (thick arrow)
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Figure 2: (a) A transverse computed tomography (CT) scan at the level of L2/3 showing a left-sided dumbbell-shaped mass (thick arrow). The posterior wall of the right intervertebral foramen was slightly eroded (thin arrow). (b) A coronal CT scan demonstrating the mildly enlarged right intervertebral foramen and dumbbell-shaped mass (thick arrow)

Mentions: A 77-year-old female presented with a 1-year history of lumbago and right-sided L3 dermatomal hypoesthesia. Her muscle strength and deep tendon reflexes were normal. Magnetic resonance imaging (MRI) of the lumbar spine revealed an irregularly-shaped, well-circumscribed paraspinal mass with minor intraspinal extension through the L2/3 intervertebral foramen. The lesion was isointense on T1-weighted (T1W) and hyperintense on T2W and diffusion-weighted images, with strong homogenous enhancement in a gadolinium (Gd) contrast study [Figure 1]. In the Gd-enhanced images, involvement of the nonenhanced right L3 nerve root in the tumor was identified [Figure 1d and e]. Computed tomography (CT) demonstrated mild enlargement of the right neural foramen at L2–3, but there were no remarkable erosive changes of the vertebral body, pedicle or lamina [Figure 2a and b]. All modalities of sensations (pin prick, touch, temperature, vibration) at the L3 dermatomes on the right side were observed. The bilateral lower limb power was normal. The results of the general examination were unremarkable, and no sensorimotor deficits were detected in the upper limbs. A presumptive diagnosis was schwannoma, but the possibility of a neurofibroma or other malignant neoplasm was considered because of the tumor's irregular shape, lack of an enlarged neural foramen and the involvement of the nonenhanced L3 nerve root. The patient underwent surgery with a lateral extracavitary approach.[18]


A case of dumbbell-shaped epidural cavernous angioma in the lumbar spine.

Yunoki M, Suzuki K, Uneda A, Yoshino K - Surg Neurol Int (2015)

(a) A transverse computed tomography (CT) scan at the level of L2/3 showing a left-sided dumbbell-shaped mass (thick arrow). The posterior wall of the right intervertebral foramen was slightly eroded (thin arrow). (b) A coronal CT scan demonstrating the mildly enlarged right intervertebral foramen and dumbbell-shaped mass (thick arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496832&req=5

Figure 2: (a) A transverse computed tomography (CT) scan at the level of L2/3 showing a left-sided dumbbell-shaped mass (thick arrow). The posterior wall of the right intervertebral foramen was slightly eroded (thin arrow). (b) A coronal CT scan demonstrating the mildly enlarged right intervertebral foramen and dumbbell-shaped mass (thick arrow)
Mentions: A 77-year-old female presented with a 1-year history of lumbago and right-sided L3 dermatomal hypoesthesia. Her muscle strength and deep tendon reflexes were normal. Magnetic resonance imaging (MRI) of the lumbar spine revealed an irregularly-shaped, well-circumscribed paraspinal mass with minor intraspinal extension through the L2/3 intervertebral foramen. The lesion was isointense on T1-weighted (T1W) and hyperintense on T2W and diffusion-weighted images, with strong homogenous enhancement in a gadolinium (Gd) contrast study [Figure 1]. In the Gd-enhanced images, involvement of the nonenhanced right L3 nerve root in the tumor was identified [Figure 1d and e]. Computed tomography (CT) demonstrated mild enlargement of the right neural foramen at L2–3, but there were no remarkable erosive changes of the vertebral body, pedicle or lamina [Figure 2a and b]. All modalities of sensations (pin prick, touch, temperature, vibration) at the L3 dermatomes on the right side were observed. The bilateral lower limb power was normal. The results of the general examination were unremarkable, and no sensorimotor deficits were detected in the upper limbs. A presumptive diagnosis was schwannoma, but the possibility of a neurofibroma or other malignant neoplasm was considered because of the tumor's irregular shape, lack of an enlarged neural foramen and the involvement of the nonenhanced L3 nerve root. The patient underwent surgery with a lateral extracavitary approach.[18]

Bottom Line: A 77-year-old female presented with a one-year history of lumbago and right-sided L3 dermatomal hypoesthesia.A dumbbell mass at the L2/3 vertebral level was identified on lumbar MRI.A presumptive diagnosis was schwannoma, but other malignant neoplasms were also considered because of its irregular shape, minimally dilated neural foramen and the involvement of the non-enhanced L3 nerve root.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan.

ABSTRACT

Background: Most spinal cavernous haemangiomas occur in the vertebral body and purely extradural cavernous hemangiomas without any vertebral body involvement is rare and account for only 4% of all extradural spinal tumors. Dumbbell-shaped spinal cavernous angioma is extremely rare, only 10 cases have been reported in the literature.

Case description: A 77-year-old female presented with a one-year history of lumbago and right-sided L3 dermatomal hypoesthesia. A dumbbell mass at the L2/3 vertebral level was identified on lumbar MRI. The lesion was irregularly shaped and isointense on T1W and hyperintense on T2W and DWI images with homogenous contrast enhancement. A presumptive diagnosis was schwannoma, but other malignant neoplasms were also considered because of its irregular shape, minimally dilated neural foramen and the involvement of the non-enhanced L3 nerve root. The patient underwent surgery with a lateral extracavitary approach. A histopathological examination revealed cavernous hemangioma.

Conclusion: Cavernous hemangioma should be included in the differential diagnosis of dumbbell-shaped spinal tumors when the intervertebral foramina is not highly dilated and non-enhanced nerve root is identified in the tumor.

No MeSH data available.


Related in: MedlinePlus