Epithelioid Hemangioma and Epithelioid Hemangioendothelioma

Abstract

55% of all tumorous intraspinal CNS-lesions are found extradurally. Epithelioid hemangiomas (EH) and epithelioid hemangioendotheliomas (EHE) are rare vascular formations of mesenchymal origin which occur in the skin, all parenchymal organs and also infrequently in vertebral bodies.

This case report describes the morphological findings in CT, MR and angiography in correlation to the histopathological examination in 3 patients and their clinical course. Patient 1: 76 yr., progressive paraplegia, initial diagnosis: hemangioma T8 with intraspinal portions. Partial resection and histopathological diagnosis EH; embolisation and re-operation with complete resection. Patient 2: 56 yr., ataxia, initial diagnosis: metastasis with osteolytic destruction T2 and intraspinal tumor. Complete resection, histopathological diagnosis: EH. Patient 3: 71 yr., osteolytic destruction T2, initial diagnosis: metastasis/tonsillary carcinoma. Complete resection, histopathological diagnosis: EHE. CT generally reveals osteolytic and soft tissue signs but MR (T1- and T2-weighted, contrast media uptake) presents varying results. EH and EHE as possibly malignant structures cannot be differentiated radiologically from each other and other vascularized masses. Embolisation prior to complete resection is helpful. EHE can furthermore metastasize lymphatically.