Hemangioblastoma, case 2

Clinical history
This 41-year-old male complained of a five month history of severe pain over the right scapular region. This pain progressively worsened and became unbearable radiating to the right arm. More recently, he also developed paresthesia of the right index and middle finger.

Neurological examination
Neurological examination was found to be normal. Still, evoked potentials were suggestive of a bilateral posterior column lesion more marked on the left.

MR examination
showed an intramedullary lesion centered on TH1 but extending from C7 to TH3.

Image 1: Sagittal T1WI a,b. On these T1 weighted sagittal images, a cystic lesion is identified at the level on TH1 (arrow). Associated edema is seen as a slightly hypointense signal area extending from C7 to TH3.
Image 2: Sagittal T2WI. On these sagittal T2 weighted images, the cystic component is well demonstrated as a high signal intensity area. Associated edema is better demonstrated than on T1WI and is seen as a moderately hyperintense signal area extending from C6 to TH3.
Image 3: Sagittal Gd T1WI. It is only after Gadolinium injection that a small, solid enhancing nodule is visible on the posterior aspect of the cystic component of the lesion.
Image 4: Axial T1WI.
Image 5: Axial GdT1WI.

On the non-enhanced axial images, only the cystic component is seen while after Gadolinium injection the solid nodule can be nicely identified on the posterior right aspect of the cystic component.

Comments
The location of the nodule at the periphery of the spinal cord is classical of hemangioblastoma. The associated cysts as well as the extensive edema over four vertebral levels are additional points in favor of the diagnosis of hemangioblastoma.

Surgery
Macroscopically total resection of the lesion was achieved.

Histology
Hemangioblastoma.

Search also:
- Hemangioblastoma

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