Vertebral Hemangioma

Vertebral Hemangioma

1. Vertebral Hemangioma Ade Wijaya, MD – January 2019

2. Introduction Extremely common lesions Mostly asymptomatic  1 % symptomatic CT/MRI C an mimic primary bony malignancies or metastases Most diagnosed in the 5th decade of life Slight female preponderance The most common location is the vertebral body of the thoracic and lumbar spine, with occasional extension to the posterior arch and involvement of multiple vertebrae Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, Colosimo C. A systematic approach to vertebral hemangioma. Skeletal radiology. 2015 Jan 1;44(1):25-36.

3. Clinical Features 55 % of these symptomatic VHs are associated with back pain alone Whereas 45 % of them can grow quickly and compress the spinal cord , nerve roots , or both, leading to neurological deficits ( aggressive or compressive VHs ) Compression is caused by bone expansion, extension into the spinal canal , disturbance of blood flow, epidural hemorrhage, and occasionally vertebral body collapse Compressive VHs can occur at any age, with peak prevalence in young adults , preferentially in the thoracic spine Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, Colosimo C. A systematic approach to vertebral hemangioma. Skeletal radiology. 2015 Jan 1;44(1):25-36.

4. Histogenesis / Pathological F eatures C omposed of capillary-sized to cavernous blood vessels Macroscopic: A soft, well-demarcated, dark red mass . It may also have a honeycomb appearance due to the intralesional sclerotic bone trabeculae and scattered bloodfilled cavities Microscopic: Thin-walled , blood-filled vessels lined with a single layer of flat endothelial cells set in a loose edematous stroma Secondary reactive phenomena such as fibrous and/or adipose involution of bone marrow and remodeling of bone trabeculae Campanacci M. Hemangioma. In: Campanacci M, editors. Bone and soft tissue tumors. Padova: Piccin Nuova Libraria &Wien: Springer ; 1999 . p. 599 – 618. Hameed M,Wold LE. Haemangioma. In: Fletcher CDM, Bridge JA, Hogendoorn P, Mertens F, editors.WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013. p. 332. Hart JL, Edgar MA, Gardner JM. Vascular tumors of bone . Semin Diagn Pathol. 2014;31(1):30 – 8. Dorfman HD, Czerniak B. Vascular lesions. In: Dorfman HD , Czerniak B, editors. Bone tumors. St. Louis: Mosby ; 1998. p . 729 – 814.

5. Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, Colosimo C. A systematic approach to vertebral hemangioma. Skeletal radiology. 2015 Jan 1;44(1):25-36.

6. TYPICAL HEMANGIOMA

7. ATYPICAL HEMANGIOMA

8. AGGRESSIVE HEMANGIOMA

9. SUMMARY Common lesions of vertebrae Mostly asymptomatic The typical radiological appearance of VHs usually allows them to be diagnosed based on a single imaging modality CT plays a central role in the workup of VHs that have an atypical appearance on MR imaging When an aggressive VH is suspected based on one imaging technique, both CT and MR imaging , and sometimes angiography, should be performed In some cases a biopsy is necessary to confirm the diagnosis Treatment only for symptomatic patients