A Case of Giant Intradural Extramedullary Capillary Hemangioma

Correspondence To the Editor: Capillary hemangioma (CH), as a benign tumor of blood vessels, commonly appears in the skin or other superficial soft tissue throughout the body among pediatric population. Spinal intradural extramedullary capillary hemangioma (IDEMCH) is rare. According to the recent review by Bouali et al., only forty cases have been reported in English literature, [1] and the size of the existing masses are generally around one vertebral length on the magnetic resonance imaging (MRI). In this paper, we report the first case of CH in the cauda equina that extends over two vertebral bodies, and discuss the diagnosis and treatment associated with such disorder. A 73‑year‑old man survived a 5‑year history of numbness in both legs, above the knee, but below the hip, and intermittent bilateral lumbocrural pain which could be exacerbated by walking and relieved by physiotherapy or rest. Roughly, a year ago, these symptoms got worsen. On admission, the patient complained of gait disturbance. The neurological physical examination revealed a weakness of the right leg, paresthesia of both lower limbs and limitation in straight leg raising test on both sides. MRI of the spine indicated a well‑circumscribed mass with 6 cm × 1.5 cm × 2 cm in size at the level of T11‑T12, in the intradural extramedullary region. The lesion appeared isointense relative to the spinal cord on T1‑weighted image (T1WI), slightly hyperintense on T2‑weighted image (T2WI) and homogeneous enhancement with the administration of gadolinium [Figure 1a‑1c]. In addition, signal void and nodular enhancement of the dura mater were also identified. Subsequently, T11‑T12 laminectomy was performed. Intraoperatively, a dark reddish nodular mass was found adhering to the cauda equina, and the surgical plane was ill‑defined between the mass and the nerve roots. Finally, the lesion was totally removed [Figure 1d] with significant bleeding occurred during the separation process. Following surgery, the patient's muscle strength of lower extremities declined and his sensation diminished below the T12 dermatome. Four weeks later, the sensory disturbance improved significantly, and the motor deficit got partially relieved. Histologically, the lesion was enveloped by the fibrous tissues, and was separated into lobular arrangement, with each lobule dominated by capillary‑sized vessels. Immunohistochemical studies showed CD31 and CD34 positive cells lining the blood vessels, and subendothelial layer appeared cells positive for smooth muscle actin [Figure 1e‑1g]. All of these features satisfied the diagnosis of CH. Hemangioma is a benign vascular disorder usually encountered in …