Epidural mass in a 37-year-old male with progressive neurologic symptoms

Abstract

Abstract Introduction/Objective A 37 yo male with progressive thoracic myelopathy (bilateral lower extremity weakness, hyperreflexia, left foot drop and bowel/bladder incontinence) visited our hospital. MRI of the thoracic spine revealed an intradural-extramedullary mass measuring 3.3 x 2.1 x 1.1 cm with severe compression and leftward and anterior displacement of the spinal cord suggestive of spinal nerve sheath tumor versus less likely meningioma. Surgery was done and an extradural mass was found which was resected via T5/6 laminectomy. Methods/Case Report Pathology received a red black irregular mass measuring 2.9 x 1.1 x 1.0 cm. H&E showed predominantly distended vascular channels lined by a single layer of flat endothelial cells and filled with red blood cells. Immunohistochemical stains CD34, S100, SOX10 and EMA were performed. CD34 was positive in endothelial cells lining the ectatic channels. S100 and SOX10 are negative ruling out spinal nerve sheath tumor. EMA was negative effectively ruling out a meningioma. The diagnosis of cavernous hemangioma was made. Results (if a Case Study enter NA) NA Conclusion Hemangiomas are benign tumors of circumscribed proliferating blood vessels and are most often found superficially in head and neck region. Cavernous hemangiomas have markedly dilated vessels as in our case. Cavernous hemangiomas of the spine are very rare and represent 5-12% of vascular lesions in the spine, with majority being an extensions from a vertebral hemangioma extending into spinal canal. Only 1-2 % are purely extradural spinal locations. Out of 54 cases, 36 were male and18 female, ages 5-78 showed 80% in the thoracic spine and 93% on the dorsal side. Patients typically present with insidious back pain, radiculopathy and myelopathy suspicious for disc herniation. They are most commonly found on the dorsal side of the thoracic spine. Epidural cavernous hemangiomas on MRI would often present as a mass and should be considered in the differential diagnosis along with nerve sheath tumors, meningiomas, abscess, and extradural hematoma.