Atypical Imaging Characteristics of Metastatic Myxoid Liposarcoma

Myxoid liposarcoma accounts for 30% to 50% of all liposarcomas, which is the second most common soft tissue tumor. It is usually painless slowly growing mass in the deep-seated soft tissue of the lower extremities or the peritoneum, with a strong metastatic predilection to the spine. Metastatic myxoid liposarcoma typically shows low signal intensity on T1 sequences with hyper-intensities on T2 sequences. In contrast to vertebral hemangioma, it shows increased signal intensity in both T1 and T2 sequences. We demonstrate 2 cases of metastatic myxoid liposarcoma with atypical MRI pattern. According to the histopathology and the clinical signs, we believe that increasing round cell cellularity and fat content is correlated to the increased T1 signal intensity and clinical aggressiveness. In conclusion, the atypical MRI pattern for vertebral metastatic lesions in patients with myxoid liposarcoma should be taken into consideration to prevent the delay in diagnosis and standard of care.

Effect of preoperative feeding artery occlusion on invasive vertebral hemangioma resection / 中国修复重建外科杂志

Objective: To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. Methods: The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A (11 cases, tumor feeding artery occlusion before operation) and group B (9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age, lesion segment, and disease duration between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale (VAS) score. Results: The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B ( P0.05). Five patients (3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation; and 2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation ( P0.05). Three patients (2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Conclusion: Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.

Percutaneous alcohol embolization combined with percutaneous vertebroplasty in epidural extension of aggressive vertebral hemangiomas / 局解手术学杂志

Objective To evaluate the safety and effectiveness of percutaneous alcohol embolization(PAE) combined with percutaneous vertebroplasty(PVP) for aggressive vertebral haemangiomas (AVHs) with epidural extension.Methods The data of 26 consecutive patients underwent PAE combined with PVP for the treatment of AVHs with epidural extension from October 2013 to November 2015 were analyzed retrospectively.The average follow-up time was (12.21 ± 1.34) months.The pain symptom before and after surgery were evaluated with a visual analogue scale (VAS).Results Pre-procedure mean VAS score was (7.23 ± 1.3) and the postoperative VAS score was (3.11 ± 1.9) at last follow-up.Ten patients (38.5％) remained asymptomatic.Eighty-eight percent of the patients with neurosensory disorders had complete regression of these symptoms.Two of the three patients with motor deficit did not show any improvement.No major complication was recorded.Conclusion PAE combined with PVP is a minimally invasive safe and effective therapeutic approach for AVH with epidural extension.This technique appears mainly effective for pain and neurosensory symptoms,but seems less effective for motor deficit relief.

A Case of an Epidural Extension of Vertebral Hemangioma Treated by Intraoperative Vertebroplasty and Laminectomy

Vertebral hemangioma is relatively common, but rarely extends into the epidural space and causes neurological deficits. This case report describes a 69-year-old woman with vertebral hemangioma extending into the epidural space causing spinal cord compression. The patient presented with low back pain and progressive weakness of the left lower extremity over a period of 1 year. Radiologic findings revealed a dural encasing vertebral hemangioma with spinal cord compression at the T11 level. After T11 vertebroplasty, the lesion was subtotally removed by T10-11 total laminectomy. The patient regained motor power of the left lower extremity postoperatively. And no further tumor growth was observed at last follow-up. This combination of intraoperative vertebroplasty and decompressive laminectomy offers a viable treatment modality for a dural encasing vertebral hemangioma with epidural extension causing cord compression.

The treatment of vertebral benign and malignant tumors with percutaneous vertebroplasty / 介入放射学杂志

Objective Vertebral benign and malignant tumors were intractable in the treatment. Previous treatment methods had their own deficiency. The introduction of percutaneous vertebroplasty brought a breakthrough in the treatment. The initial experience of the treatment of vertebral malignant and benign tumors with percutaneous vertebraplasty was analyzed in this clinical research.Methods and materials The treatment of seven cases of vertebral hemangiomas and 11 cases of vertebral malignant tumors were reported. Unipedicular or bipedicular approaches were used in 17 cases, and in one case of cervical hemangioma, the cervical anterior-lateral approach was adopted. 15-20% of bone cement was mixed and injected into the vertebral lesions and made to distribute and cast in the lesions. Results Good results were got in all the 18 cases. After 0.5-7ml of cement was injected into the lesions. The complete relief was got in 10 cases and sub-complete relief was achieved in 6 cases and medial relief was got in two cases. One to nine months of postoperative follow-ups found no recurrences.Conclusions The treatment of vertebral benign and malignant tumors with percutaneous vertebraplasty was mini-invasive, safe, and effective.

Spinal Cord Compression Caused by Vertebral Hemangioma: Usefulness of Intra-Operative Vertebroplasty

Vertebral hemangioma is the most common benign spinal tumor. It is usually asymptomatic and extraosseous extension causing spinal cord compression with neurologic symptoms is rare. Pre-operative angiography and embolization should be done for definite diagnosis and prevention of excessive blood loss during the operation. In author's case, pre-operative angiography was done for diagnosis, but unfortunately embolization procedure was not available. We performed intra-operative vertebroplasty with polymethylmethacrylate(PMMA) for the prevention of excessive blood loss during the operation and the maintenance of postoperative stability.

The Synthetic Treatment in Vertebral Hemangioma / 实用放射学杂志

Objective To assess the efficacy of radiotherapy and synthetic therapy for vertebral hemangiomas.Methods Clinical symptoms,imaging findings,therapeutic methods and following up after treatment in 22 cases with vertebal hemangiomas were retrospectively analyzed.Results Complete relief of symptoms(CR)were occurred in 19 of 22 patients(86.4%) and partial relief(PR)were achieved in 3 of 22 patients(13.6%).There was no obvious complication of radiotherapy and radiation-induced neoplasms.There was no relapse.Conclusion For vertebral hemangioma,the synthetic therapy which includes intenventional therapy before operation as well as radiotherapy after operation is of obvious superiority in relieving compression rapidly,reducing hemorrhage during operation and obtaining good efficacy.

A Case of Vertebral Hemangioma Diagnosed with the Assistance of Tc-99m RBC SPECT

Vertebral hemangioma is a slow-growg, benign tumor which is often discovered incidentally during evaluation of neck or back pain.1,2 It is easily demonstrated by spine MRI, but in some cases did not show typical radiological appearance. In that case, Tc-99m RBC SPECT may be another confirmatory diagnostic tool. We report a case of vertebral hemangioma diagnosed with the assistance of Tc-99m RBC SPECT.

Vertebral Hemangioma Causing Cord Compression: A Case Report

We present a case of thoracic vertebral hemangioma causing spinal cord compression in a 57-year-old man. It is not common for vertebral hemangioma to cause neurologic deficits. The chief complaint of the patient was progressive paraparesis. Plain T-spine x-rays appeared normal. Axial and sagittal T1-weighted magnetic resonance(MR) imagings of T-spine showed multiple ring-like high signal lesion in vertebral body and decreased signal intensity at T7 with epidural mass causing spinal cord compression. Decompressive laminectomy and subtotal removal of the epidural mass were performed. The mass was reddish, friable and easily-coagulated. The postoperative computerized tomography(CT) scan of T-spine demonstrates characteristic thick vertical trabeculae and honeycomb pattern involving body and pedicles of T7 vertebrae. Bowel and urinary incontinence returned to normal two weeks following operation, and the patient was discharged with walking by sue of crutch three weeks later. Based on clinical features with this patient review of the literature, the authors recommend annual neurological and radiological examinations for patients harbouring hemangiomas with associated pain. Radiation therapy or embolization is an effective therapeutic alternative for patients with severe medically refractory pain. It is concluded that management of patients with a progressive neurological deficit should include prompt preoperative angiography and embolization, decompressive surgery with the approach determined by the degree of vertebral involvement and site of spinal cord compression, and postoperative radiation therapy in patients following subtotal tumor removal.

A Case of Symptomatic Vertebral Hemangioma with Epidural Mass

A case of upper thoracic vertebral hemangioma with epidural mass is reported. Preoperative selective angiography with embolization is the procedure of choice for reducing intraoperative bleeding. There was progressive postoperative improvement of the myelopathy.

Two Cases of Epidural Cavernous Hemangioma in the Thoraic Spine

The reports of epidural vascular tumors are rare however dumbbell-shaped epidural cavernous hemangioma is exceedingly rare. The reported incidence of epidural hemangiom is 4%of all spinal epidural tumors and 12% of all intraspinal hemangioma. In the majority of cases, hemangiomas of spinal epidural space represent the secondary extension of a vertebral hemangioma but the occurance of pure epidural cavernous hemangioma is relatively rare. In this report, authors present two cases of epidural cavernous hemangioma including one dembbell-shaped in the thoracic spine with review of other reports.