A 39-year-old woman presented with neck and shoulder pain for 3 months. The MRI scan revealed a cystic-solid lesion located at C5 (figure 1, A–E). The patient received an operation and a small blood blister–like soft mass was detected. The tumor originated from proximal cervical nerve root and compressed the spinal medulla (figure 2, A–C). Pathologic diagnosis was hemangioblastoma (figure 2D). Postoperative gadolinium-enhanced MRI showed a gross total resection of the tumor (figure 1F). Spinal hemangioblastomas frequently originate from the medulla,1 and nerve root originated hemangioblastoma is scarce. Our case provides a direct-viewing description and pathologic confirmation of a new subset of classification for origin of spinal hemangioblastomas.
Preoperative imaging revealed a hypointensity mass in sagittal T1 (A) and hyperintensity in T2-weighted imaging (B). The lesion was cystic-solid in sagittal (C) and coronal (D) imaging after administration of gadolinium and axial enhanced MRI (E) showed it was extramedullary. Postoperative contrast-enhanced MRI (F) depicted the tumor was totally resected.
During operation, a soft blood blister–like mass was detected (A). After carefully dissecting it, we found that the lesion arose from the proximal cervical nerve root (arrow), compressing the spinal medulla (asterisks) (B). The tumor was totally resected so that the nerve root (arrow) and spinal medulla (asterisks) were revealed (C). Hematoxylin & eosin (magnification, ×200) (D) showed large intratumoral vascular channels, loose stromal elements, and prominent capillaries characteristic of a hemangioblastoma; the nerve root tissue (asterisks) is surrounded by tumor stroma.
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↵* These authors contributed equally to this work.
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