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Epithelioid Hemangioma of the Spine: A Case Series and Treatment Flow Chart—Experience from a Single Centre
by
, , and
Emanuela Asunis
1,†,
Chiara Cini
1,†,
Mario De Robertis
2,3,
Cristiana Griffoni
1,*,
Stefano Bandiera
1,
Alberto Righi
4,
Riccardo Ghermandi
1,
Valerio Pipola
1,
Marco Girolami
1,
Giuseppe Tedesco
1,
Marco Gambarotti
4 and
Alessandro Gasbarrini
1,5 1
Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
2
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
3
Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
4
Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
5
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
*
Author to whom correspondence should be addressed.
†
These authorscontributed equally to this work.
Cancers 2024, 16(14), 2557; https://doi.org/10.3390/cancers16142557 (registering DOI)
Submission received: 29 May 2024
/
Revised: 5 July 2024
/
Accepted: 11 July 2024
/
Published: 16 July 2024
(This article belongs to the Special Issue Surgical Treatment of Spinal Tumors)
Simple Summary
Epithelioid vascular tumors are rare bone vascular lesions with a spectrum of overlapping cancer entities with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphologic features, and unpredictable biologic behavior. The classification of vascular tumors of bone proposed by the World Health Organization in 2020 incorporated morphologic findings with available genetic evidence, including mainly angiosarcoma, epithelioid hemangioma, pseudomyogenic hemangioendothelioma, and epithelioid hemangioendothelioma. Here, we report our experience with eleven patients suffering from epithelioid hemangioma (EH) of the spine. As very few cases of EH of the spine have been reported in the literature, the evidence-based decision-making process for these patients can be very difficult. Thus, we propose a treatment flowchart based on our single center’s experience.
Abstract
Epithelioid hemangioma is recognized by the World Health Organization as a distinct benign neoplasm; however, it is characterized by locally aggressive and rarely metastasizing behavior. Epithelioid vascular tumors are rare bony vascular lesions with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphological features, and unpredictable biological behavior. The application of new molecular tools, such as massive parallel sequencing technologies, have provided new diagnostic markers and an opportunity to further refine the classification of bone vascular neoplasms. Very few cases of EH of the spine have been reported in the literature; therefore, it is difficult to make evidence-based therapeutic decisions for these patients. We report herein our experience with eleven patients suffering from EH of the spine. The study population included three males and eight females treated in our center from 2016 to the present; the average age was 44.8 years (range 14–75 years). The surgical, clinical, and radiographic data were retrospectively analyzed. The mean follow-up was 34.8 months. All patients presented lytic vertebral body lesions, six of them with pathological fracture. The majority of patients (80%) presented myelo-radicular compression. All patients were surgically treated, and preoperative embolization was performed in all cases. In light of the literature review and the clinical experience of our center, we can consider EH a locally aggressive tumor that requires surgical treatment in case of symptoms. Here, we propose a treatment algorithm that could be useful in the management of patients with this rare disease.
