Congenital mesenchymal chondrosarcoma of the orbit: case report and review of the literature.

Purpose
We intend to report the largest series of spinal epidural cavernomas (SEC), discuss their clinical features, imaging characteristics, surgical findings, outcome analysis and compare them with similar reports in the literature.

/pdf/solitary-spinal-epidural-cavernous-angioma-report-of-nine-wbpsytfis7.pdf

Solitary spinal epidural cavernous angioma: report of nine surgically treated cases and review of the literature.

Objective Image-guided stereotactic radiosurgery (SRS) was applied to a case of spinal epidural cavernous hemangioma in the thoracic spine. This report demonstrates the potential for spinal SRS in treating diseases that have previously required extensive invasive surgery. Clinical presentation A 27-year-old woman with gait disturbance and shoulder pain radiating into the right upper arm and back presented for clinical evaluation. Magnetic resonance imaging revealed an extraforaminal epidural mass compressing the spinal cord at the T1-T2 and T2-T3 levels of the intervertebral foramen. The patient had previously undergone a decompressive laminectomy and open biopsy. Several months after this surgery, her radiculomyelopathy had not improved and appeared to be progressing. Intervention Intensity-modulated hypofractionated radiosurgery was performed on the lesion. The patient's radicular pain was remarkably improved within days, and associated neurological symptoms had largely disappeared within a few months. Subsequent follow-up magnetic resonance imaging at 12 and 36 months showed that the tumor mass was greatly reduced. No evidence of any complications associated with irradiation was apparent, and the patient continued to demonstrate a positive prognosis. Conclusion A thoracic epidural cavernous hemangioma of proven pathology was successfully treated using state-of-the-art, spinal image-guided SRS. Based on our experience with other types of tumors, we determined that an effective treatment modality for this pathology would be a hypofractionated dose of 32 Gy in 4 fractions. This treatment protocol delivered rapid clinical benefits and long-term tumor control demonstrating the viability of SRS in the treatment of this difficult and rare condition.

Spinal radiosurgical treatment for thoracic epidural cavernous hemangioma presenting as radiculomyelopathy: technical case report.

Purpose To describe a patient with mesenchymal chondrosarcoma of the orbit, review clinical and imaging findings, and refine the differential diagnosis from other tumors of the orbit. Methods Interventional case report and literature review. Results A 21-year-old woman with a 6-month history of progressive proptosis presented with left-sided visual loss of recent onset. CT revealed a clearly outlined heterogeneous mass with calcified foci, whereas MRI showed an isointense signal to gray matter on T1- and T2-weighted images. The patient was diagnosed with mesenchymal chondrosarcoma of the orbit only after orbitotomy and subsequent histopathologic study. After surgery, she received adjuvant therapy with irradiation of the orbit. Conclusions Mesenchymal chondrosarcoma is a rare malignant tumor of the orbit capable of mimicking several other lesions. Early diagnosis requires a high level of suspicion, particularly with regard to internally calcified lesions. The treatment of choice is complete surgical resection, or, when the tumor is not resectable or residual mass is present after surgery, chemotherapy and radiotherapy. Prognosis for patients with orbital mesenchymal chondrosarcoma is tentative at best, in part because of the rarity of the lesion.

Mesenchymal chondrosarcoma of the orbit.

Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated. The patient, a 27-year-old man presented with acute onset of pain, paraesthesia, and numbness within the right leg corresponding to the S1 segment. An acute lumbosacral disc herniation was suspected, but MRI revealed a cystic lesion with the shape of a balloon, a fluid level and a thickened contrast-enhancing wall. Intraoperatively, a purple-blue tumor with fibrous adhesions was located between the right S1 and S2 nerve roots. Macroscopically, no signs of epidural bleedings could be denoted. After coagulation of a reticular venous feeder network and dissection of the adhesions the rubber ball-like lesion was resected in total. Histology revealed a prominent venous vessel with a pathologically thickened, amuscular wall surrounded by smaller, hyalinized, venous vessels arranged in a back-to-back position typical for the diagnosis of a cavernous angioma. Lumina were partially occluded by thrombi. The surrounding fibrotic tissue showed signs of recurrent bleedings. There was no obvious mass hemorrhage into the surrounding tissue. In this unique case, the pathologic mechanism was not the usual rupture of the cavernous angioma with subsequent intraspinal hemorrhage, but acute mass effect by intralesional bleedings and thrombosis with subsequent increase of volume leading to nerve root compression. Thus, even without a sudden intraspinal hemorrhage a spinal cavernous malformation can cause acute symptoms identical to the clinical features of a soft disc herniation.

/pdf/intralesional-hemorrhage-and-thrombosis-without-rupture-in-a-3ybc7214th.pdf

Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy

Imaging features of spinal epidural cavernous malformations

Mesenchymal extraskeletal chondrosarcoma of the orbit. Report of a case and review of the literature.

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Imaging features of spinal epidural cavernous malformations

Mesenchymal extraskeletal chondrosarcoma of the orbit. Report of a case and review of the literature.