Table 1 Case series of spinal haemangiomas with radiological–pathological correlation

1

67-year-old man with history of a spinal haemangioma excised 14 years previously. Followed radiologically without evidence of recurrence.

Subsequently diagnosed with prostate cancer

6 years later, treated with local radiotherapy and hormone therapy. Developed new thoracic back pain 2 years following this, without neurologic deficit.

MRI images (a) and (b) show extensive abnormal signal in the T8 vertebral body extending into the posterior elements, and a mass in the spinal canal at the level of T8.

Bone biopsy was performed to exclude prostate metastasis. Patient is currently being managed conservatively.

Haematoxylin and eosin stain of biopsied vertebral lesion (c) confirms a recurrent haemangioma with no evidence of metastatic prostate carcinoma.

2

35-year-old man with background of Henoch-Schonlein purpura and end-stage renal disease. Presented with a 1-week history of gait disturbance. Hyperreflexia and hypertonia on examination, with a sensory level at T6.

MRI images (a), (b), (c) and (d) show an enhancing extradural mass within the spinal canal extending from T5 to T7.

Underwent T6-T7 laminectomy and resection of spinal mass. At surgery the mass was noted to bleed significantly. Uncomplicated postoperative course with improved symptoms.

Haemotoxylin and eosin stain of excised extradural spinal mass (e) confirms a haemangioma.

3

16-year-old boy with 3-week history of progressive paraesthesia and gait disturbance. On examination had sensory level at T8.

MRI images (a) and (b) show abnormal high signal in the posterior two-thirds of the T6 vertebral body extending into the posterior elements, and an associated enhancing extradural mass posterior to the cord extending from T5 to T7.

Underwent preoperative embolisation followed by T5–T7 laminectomy and excision of the spinal mass. Improved neurological symptoms postoperatively but developed kyphosis at the level of the previous surgery, which required subsequent surgical fixation. A digitally subtracted image is shown from the embolisation procedure. Selective angiography of the left T6 lumbar artery shows enhancement of the T6 vertebra and associated soft tissue mass (d).

Haemotoxylin and eosin stain of excised extradural spinal mass (e) confirms a haemangioma.

4

74-year-old woman with 2-year history of bilateral upper limb clumsiness and episodic upper limb spasms

MRI images (a), (b) and (c) show an enhancing 4-cm intradural mass at the level of T1 extending through the right neural foramen. There is associated signal abnormality within the T1 vertebra and cortical destruction.

Underwent C7–T2 laminectomy and attempted resection of the spinal mass. The procedure was abandoned due to extensive intraoperative bleeding. The mass was subsequently embolised, and the patient underwent successful complete excision.

Haematoxylin and eosin stain of excised intradural spinal mass with bone erosion (d) confirms a haemangioma.

5

36-year-old man with progressive difficulty walking and diminished sensation in the lower limbs over 6 months. Hyperreflexia and reduced power (4/5) on examination, with sensory level at T10.

MRI images (a) and (b) show an enhancing intradural extramedullary mass at the level of T10 extending out through the left neural foramen.

Underwent T10 laminectomy and excision of spinal mass. Symptoms of myelopathy resolved postoperatively.

Haemotoxylin and eosin stain of excised intradural extramedullary spinal mass (c) confirms a haemangioma.

6

68-year-old woman with 8-week history of lower back pain with associated paraesthesia in the left lower limb. On examination, reduced power in both lower limbs (3/5 on left side and 4/5 on right side)

MRI images (a), (b) and (c) show an enhancing intradural mass at the T9–T10 disc space.

Underwent T8–T10 laminectomy and excision of spinal mass. Made a slow improvement postoperatively.

Haemotoxylin and eosin stain of excised intradural spinal mass (d) confirms a haemangioma.