Neurosurgical Management of Spinal Epithelioid Hemangioendothelioma: Systematic Review & Illustrative Case Presentation

World Neurosurg. 2024 May 9:S1878-8750(24)00759-9. doi: 10.1016/j.wneu.2024.05.006. Online ahead of print.

Abstract

Background: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor predominantly arising in soft tissue. We report a rare case of thoracic spinal EHE with pulmonary metastasis.

Methods: Case report and systematic review of spinal EHE.

Results: A 36-year-old man presented with bilateral lower extremity weakness, progressive paresthesia, and urinary incontinence. He underwent open surgical resection of the tumor and decompression of the spinal cord, with subsequent improvement in neurological function. Systematic review identified 84 cases of spinal EHE, 73 of which were primary, and 14 of which developed extra-spinal metastases.

Conclusion: EHE is an exceedingly rare tumor that may present with a wide swath of clinical symptoms. At present, no guidelines or formal treatment recommendations have been established. Surgical debulking has demonstrated efficacy as a front-line treatment, particularly in the setting of compressive neurological dysfunction; data regarding adjuvant chemoradiation are less consistently reported, mandating further study.

Keywords: Epithelioid hemangioendothelioma; metastasis; novel genotypic abnormalities; recurrence.

Publication types

  • Review