engleski

SPINDLE CELL HEMANGIOMA WITH THE ATYPICAL LOCATION

INTRODUCTION: Spindle cell hemangioma is a vascular tumor first described as a new entity in 1986 by Weiss and Enzinger, as a rare type of haemangioma. The tumor occurs usually in young adults and affects the subcutis of distal extremities or arose in the small bones of the hands, feet and tibia. Location within the canalis spinalis is extremely rare. CASE REPORT: A 31 year-old male patient complained on weakness of both legs that started in May 2005. In September 2005 he noticed paresthesias in both legs that slowly progressed toward his stomach. He was admitted at our Department of neurosurgery in March 2006 due to progressive weakness of his legs. Upon admission the neurological examination revealed a spastic paraparesis (3/5), hyperactive reflexes and paresthesias distal from Th10 dermatome. MR of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5, 3 x 1, 2 cm at the Th1-Th3 level. Intraoperatively, C7-Th3 laminectomy was performed. On the right side of the spinal canal, a purple-grayish tumorous lesion was visualized. It was located extradurally compressing the dura to the left. The lesion was well demarked from the dura, and it was removed completely in a microneurosurgical manner. Histologically H&E slides revealed a lesion which was composed of thin-walled cavernous vessels lined by flattened endothelial cells and containing thrombi. There were cellular spindled stromal areas between the cavernous spaces that were assumed to be representing collapsed small vascular canals. Some of endothelial cells contained prominent intracytoplasmatic vacuoles. Postoperative recovery was uneventful. Paresthesias regressed almost immediately after surgery and the amelioration of leg weakness was noticed. MATERIAL AND METHODS: Immunohistochemical analysis of CD 34, Vimentin, SMA and Ki - 67 (DAKO, Copenhagen, Denmark) was performed in formalin fixed and paraffin embedded tumor tissues. As a visualization system labeled streptavidin biotin method (LSAB) was used on Dako Tech Mate automatic immunostainer using microwave streptavidin immunoperoxidase-MSIP protocol. DISCUSSION AND CONCLUSION: occasionally the spindle cell hemangioma is associated with Maffucci syndrome and was also seen in the Klippel-Trenaunay syndrome. The tumor arose in the vicinity of clearly abnormal vessels, supporting the idea that the spindle cell hemangioma is most likely a vascular malformation in which variation in blood flow gives rise to alternating areas of vascular expansion and collapse. Although, usually it was believed to be a tumor with limited metastatic potential and it is regarded as a benign tumor, about 60% of spindle cell hemangiomas recur and there is no evidence that these lesions have the ability to metastasize. This case is reported as a unique location of this rare type of hemangioma in the spinal canal.

spindle cell hemangioma; atypical location

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