Wang GX, Chen YQ, Wang Y, Gao CP. Atypical aggressive vertebral hemangioma of the sacrum with postoperative recurrence: A case report. World J Clin Cases 2022; 10(34): 12648-12653 [PMID: 36579090 DOI: 10.12998/wjcc.v10.i34.12648]
Corresponding Author of This Article
Chuan-Ping Gao, MD, Doctor, Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266003, Shandong Province, China. gaochuanping2021@163.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2022; 10(34): 12648-12653 Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12648
Atypical aggressive vertebral hemangioma of the sacrum with postoperative recurrence: A case report
Guan-Xi Wang, Yun-Qing Chen, Yan Wang, Chuan-Ping Gao
Guan-Xi Wang, Department of Radiology, Songshan Hospital of Qingdao University Medical College University, Qingdao 266000, Shandong Province, China
Yun-Qing Chen, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Yan Wang, Chuan-Ping Gao, Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Author contributions: Wang GX and Wang Y reviewed the literature and drafted the manuscript; Chen YQ served as the pathologist, reviewed the literature, and drafted the manuscript; Gao CP proofread the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chuan-Ping Gao, MD, Doctor, Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266003, Shandong Province, China. gaochuanping2021@163.com
Received: July 4, 2022 Peer-review started: July 4, 2022 First decision: August 1, 2022 Revised: August 5, 2022 Accepted: November 7, 2022 Article in press: November 7, 2022 Published online: December 6, 2022
Abstract
BACKGROUND
Aggressive vertebral hemangioma (VH) is an uncommon lesion in the adult population. The vast majority of aggressive VHs have typical radiographic features. However, preoperative diagnosis of atypical aggressive VH may be difficult. Aggressive VHs are likely to recur even with en bloc resection.
CASE SUMMARY
A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity. Physical examination showed sacral tenderness and limited mobility, and the muscle strength was grade 4 in the right digital flexor. Computed tomography revealed osteolytic bone destruction from S1 to S2. Magnetic resonance imaging (MRI) showed that the mass was compressing the dural sac; it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI, and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1. The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively, and MRI examination showed recurrence of the mass. The mass was larger in size than before the operation, and it was extending into the spinal canal.
CONCLUSION
The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction, extension of the mass into the spinal canal, and heterogeneous signal intensity on T1-, T2-, and enhanced T1-weighted MRI. These characteristics make preoperative diagnosis difficult, and biopsy is necessary to verify the lesion. Surgical decompression and gross total resection are recommended for treatment of aggressive VH. However, recurrence is inevitable in some cases.
Core Tip: Aggressive vertebral hemangioma is characterized by osteolytic vertebral bone destruction and may extend into the spinal canal. Atypical aggressive vertebral hemangioma exhibits heterogeneous signal intensity on T1-, T2-, and enhanced T1-weighted magnetic resonance imaging. Recurrence is inevitable in some cases.
