Primary Lymphangioma of Bone

Intradural cavernous lymphangioma of the thoracic spine: case report, technical considerations, and review of the literature

BACKGROUND CONTEXT

Cavernous lymphangioma is a rare slow-growing tumor that can cause neurologic compromise when it involves the central nervous system. Involvement of the spinal column is rare but may involve the osseous structures or the epidural space of the spinal column.

PURPOSE

We report the first case of an intradural, extramedullary cavernous lymphangioma involving the thoracic spinal cord.

METHODS

An 83-year-old woman presented with progressive gait ataxia, bilateral lower extremity weakness, and a band-like sensation in the middle and lower thoracic dermatomes. Magnetic resonance imaging of the thoracic spinal cord revealed hyperintensity on T2 and enhancement of an intradural cystic mass along the dorsal aspect of the T5-T8 levels with significant compression of the spinal cord.

RESULTS

Complete surgical resection was difficult owing to the adherence of the tumor to the pial surface and microvasculature of the thoracic spinal cord. Recurrence of the mass was ultimately treated with cystic fluid diversion into the peritoneum. At her follow-up visit after 28 months, the patient was able to ambulate with minimal assistance. A comparative literature review is presented. There are no reports of intradural thoracic spinal cord involvement in the literature.

CONCLUSIONS

Intradural cavernous lymphangioma of the spine poses a unique surgical challenge for complete resection. Cystic fluid diversion appears to be a viable treatment option with lasting benefit if complete resection is not achieved.

A rare case of lumbar vertebral lymphangioma presenting as chylothorax

BACKGROUND CONTEXT

The lumbar lymphangioma occurs rarely. Several studies have presented cases with the involvement of multiple vertebrae in presence or absence of the other bones and/or adjacent soft tissue. We elucidate a rare case of lumbar lymphangioma which presents as chylothorax.

PURPOSE

To report a rare case of lumbar lymphangioma presenting as chylothorax.

STUDY DESIGN

A case report.

METHODS

A 32-year-old man was admitted with lumbar and chest pain. Lumbar plain radiography, computed tomography (CT) scan and magnetic resonance imaging revealed L2 vertebra's sclerosis and destruction with canal compression leading up to vertebral lymph/hemangioma impression. Chest radiograph revealed a left-sided pleural effusion that further examination confirmed the chylothorax. Because of medical treatment failure in managing the chylothorax, surgical exploration was performed on. The involved vertebra was resected and stabilized with a mass ligation of its adjacent soft tissues. Histopathologic study of the resected material confirmed the diagnosis of lymphangioma. Serial plain radiography and CT scan were performed at postoperative follow-up.

RESULTS

Following up assessments showed that the chylothorax resolved. Also, the pain significantly relieved.

CONCLUSION

To the authors' knowledge, this is a unique reported case of lymphangioma affecting lumbar vertebral body presenting as chylothorax. Further observation is recommended because of the possibility of local recurrence.

A rare case of cavernous lymphangioma in the epidural space of the cervicothoracic spine

STUDY DESIGN

A case report.

OBJECTIVES

To report and discuss a case of lymphangioma in the epidural space of the cervicothoracic spine.

SUMMARY OF BACKGROUND DATA

Lymphangioma of the soft tissue is not uncommon, but lymphangiomas presenting as a spinal soft tissue tumor in the epidural space are extremely rare.

METHODS

A 61-year-old woman with pain and numbness in the left arm. Magnetic resonance imaging demonstrated a half ring-shaped soft tissue mass in the left epidural space from the C6 to T1 level. The patient underwent osteoplastic laminectomy from C6 to T1. Histopathologic diagnosis of the resected tumor was cavernous lymphangioma.

RESULTS

One year after the operation, the patient reported mild pain in left upper limb, but there was no evidence of local recurrence on magnetic resonance imaging.

CONCLUSION

To the authors' knowledge, this is an extremely rare reported case of lymphangioma presenting as a spinal soft tissue tumor in the cervicothoracic epidural space. Further observation is recommended because of the possibility of local recurrence.

Gorham Disease of the Spine: A Case Report and Treatment Strategies for This Enigmatic Bone Disease

Gorham disease is an extremely rare condition of unknown etiology characterized by progressive osteolysis. Only 28 cases of its spinal involvement have been reported, and some of those cases showed kyphosis, kyphoscoliosis, subluxation or dislocation. No definite regimen of treatment has been established yet. A 10-year-old boy presented with a severe and progressive kyphosis over 90 degrees caused by Gorham disease from T3 to T12. In situ posterior fusion with a hook and rod system and iliac bone grafts were performed, but after surgery, he had complete paraplegia and its cause was uncertain. Based on the unfortunate consequence of the present case and the review of the literature, we propose the treatment strategies for spinal Gorham disease.

Lymphangioma presenting as a dumbbell tumor in the epidural space of the lumbar spine

STUDY DESIGN

A case report.

OBJECTIVES

To report and discuss a case of lymphangioma presenting as a dumbbell-shaped tumor in the epidural space of the lumbar spine.

SUMMARY OF BACKGROUND DATA

Dumbbell tumor of the spine is not uncommon. Although the pathogenesis of such tumors varies widely, lymphangioma has not been reported previously, to these authors' knowledge.

METHODS

A 56-year-old woman with pain in the lower back and left leg was examined by plain radiographs and magnetic resonance imaging before surgery. Treatment consisted of the usual technique of surgical resection of the tumor. Histopathologic study of the resected material confirmed the diagnosis. Postoperative follow-up assessment was performed by magnetic resonance imaging.

RESULTS

Magnetic resonance imaging demonstrated a dumbbell tumor in the epidural canal area of the lumbar spine. Histopathologic diagnosis of the resected tumor was cavernous lymphangioma.

CONCLUSION

To the authors' knowledge, this is the first reported case of lymphangioma presenting as a spinal dumbbell tumor. Further observation is recommended because of the possibility of local recurrence.

Intraosseous lymphangiomas of the mandible

Central lymphangioma of bone is a rare entity which has not previously been reported in the English language literature as occurring in the mandible. Two cases of intraosseous lymphangioma of the mandible from the files of the Armed Forces Institute of Pathology are presented. While these lesions have clinical and radiographic features similar to hemangioma of bone, they do not pose the surgical hemorrhage control problems of hemangiomas. Solitary lymphangioma of bone may share similar histologic features with the disease entities systemic cystic angiomatosis and massive osteolysis. These latter two entities may cause complicated clinical management problems; curettage, however, is adequate therapy for solitary, localized lymphangioma of bone.

Lymphangioma of the craniocervical junction. Case report

✓ A case of lymphangioma involving bone, primarily the skull and cervical spine, is reported. Pathological and therapeutic considerations are summarized.