Sir,A 58-year-old male, a known case of renal transplantation on immunosuppressive therapy since 4 years, presented with gait problem of one month duration and recent onset of lower extremity paresthesias. Neurologic examination showed mild asymmetric spastic paraparesis, hyperreflexia, and bilateral up-going plantar response. The sensory level was at T6-8 level. Dorsal spine magnetic resonance imaging (MRI) showed a well circumscribed extradural mass (3x1 cm) extended from T4 to T6 level and vertebral hemangioma (VH) involving T4 and T5 vertebral bodies [Figure la]. Patient was scheduled for decompression surgery and specimen was sent for tissue diagnosis. Histopathology showed intravascular anastomosing vascular channels and papillary formation with hyaline core [Figure lb]. These structures were covered by plump endothelial cells and in some areas, residual thrombi were evident [Figure lc]. There was no cellular atypia, necrosis, and mitotic activity. The histological features were suggestive of an intra-vascular papillary endothelial hyperplasia (IPEH) or Masson's hemangioma. Following surgery, the patient had gradual improvement in the neurologic deficits. At 6-month follow-up, he is symptom-free with no complications.
展开▼
