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October 27, 2020; 95 (17) NeuroImages

Spinal hemangioblastoma arising from cervical nerve root

Jiuhong Li, Jiaojiang He, Susu Lu, Xuhui Hui, Haifeng Chen
First published September 15, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010836
Jiuhong Li
From the Departments of Neurosurgery (J.L., J.H., X.H., H.C.) and Pathology (S.L.), West China Hospital of Sichuan University, Chengdu.
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Jiaojiang He
From the Departments of Neurosurgery (J.L., J.H., X.H., H.C.) and Pathology (S.L.), West China Hospital of Sichuan University, Chengdu.
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Susu Lu
From the Departments of Neurosurgery (J.L., J.H., X.H., H.C.) and Pathology (S.L.), West China Hospital of Sichuan University, Chengdu.
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Xuhui Hui
From the Departments of Neurosurgery (J.L., J.H., X.H., H.C.) and Pathology (S.L.), West China Hospital of Sichuan University, Chengdu.
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Haifeng Chen
From the Departments of Neurosurgery (J.L., J.H., X.H., H.C.) and Pathology (S.L.), West China Hospital of Sichuan University, Chengdu.
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Citation
Spinal hemangioblastoma arising from cervical nerve root
Jiuhong Li, Jiaojiang He, Susu Lu, Xuhui Hui, Haifeng Chen
Neurology Oct 2020, 95 (17) 791-792; DOI: 10.1212/WNL.0000000000010836

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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.

Figure 1
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Figure 1 MRI findings

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.

Figure 2
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Figure 2 Operative and pathologic findings

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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No targeted funding reported.

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The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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Table1

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • © 2020 American Academy of Neurology

Reference

  1. 1.↵
    1. Westwick HJ,
    2. Giguere JF,
    3. Shamji MF
    . Incidence and prognosis of spinal hemangioblastoma: a surveillance epidemiology and end results study. Neuroepidemiology 2016;46:14–23.
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