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<p>Epithelioid hemangioma (EH) is a rare benign vascular tumor with infrequent spinal involvement, often mimicking malignant or infectious processes, posing diagnostic challenges. We report a 33-year-old male with progressive back pain, lower limb weakness, and urinary/bowel dysfunction. Imaging revealed multifocal marrow lesions, pathological L4 collapse, and spinal cord compression, initially suggesting multiple myeloma. He underwent extensive spinal surgery with D7-D8 and L3-L4 laminectomies, mass excision, decompression, and multilevel fusion. Intraoperatively, a large epidural mass with extensive bony involvement was noted. Histopathology confirmed EH with epithelioid endothelial cells and eosinophilic infiltrates, supported by CD31/CD34 immunopositivity. Postoperatively, neurological improvement was minimal, and the patient declined radiation therapy, potentially affecting disease control. Spinal EH, though rare, should be considered in patients with progressive neurological deficits. Diagnosis relies on histopathology and immunohistochemistry, while surgery remains crucial for decompression and stabilization. Prognosis varies with disease extent, and the role of adjuvant therapy remains unclear, necessitating further research for standardized management.</p>

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Multifocal Epithelioid Hemangioma of the Spine Mimicking Metastatic Disease: A Rare Entity with a Complex Clinical Course

  • 期刊论文

  • 发表日期：

    2025年6月10日

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  • Sanjay Kumar Gupta,
  • Mukesh Kumar Garg,
  • Abhishek Pareek,
  • Parikshit Nagda

摘要

Epithelioid hemangioma (EH) is a rare benign vascular tumor with infrequent spinal involvement, often mimicking malignant or infectious processes, posing diagnostic challenges. We report a 33-year-old male with progressive back pain, lower limb weakness, and urinary/bowel dysfunction. Imaging revealed multifocal marrow lesions, pathological L4 collapse, and spinal cord compression, initially suggesting multiple myeloma. He underwent extensive spinal surgery with D7-D8 and L3-L4 laminectomies, mass excision, decompression, and multilevel fusion. Intraoperatively, a large epidural mass with extensive bony involvement was noted. Histopathology confirmed EH with epithelioid endothelial cells and eosinophilic infiltrates, supported by CD31/CD34 immunopositivity. Postoperatively, neurological improvement was minimal, and the patient declined radiation therapy, potentially affecting disease control. Spinal EH, though rare, should be considered in patients with progressive neurological deficits. Diagnosis relies on histopathology and immunohistochemistry, while surgery remains crucial for decompression and stabilization. Prognosis varies with disease extent, and the role of adjuvant therapy remains unclear, necessitating further research for standardized management.