LAUSR

Dear Editor The patient was a 1–year-old girl with quadriparesis for one month. Spinal magnetic resonance imaging (MRI) revealed a 10*72*20 mm posterior epidural lesion between C4 and T4 level which was hyperintense in T1 weight sequences and heterogeneous in T2 weight sequences with peripheral enhancement and compression of the cord (Fig. 1). Radiologic findings were in favor of an epidural hematoma in the background of a vascular malformation. Subsequently, osteoplastic laminectomy of C3 to T4 vertebrae was performed and extradural subacute hematoma with cherry red appearance along with a soft tissue lesion was resected. Bony elements and dura were not involved. Histopathologic findings were disorganized dilated venous vessels with a collagenized thrombosis and intravascular papillary endothelial hyperplasia (Fig. 2). Intravascular papillary endothelial hyperplasia (IPEH) was first described by Pierre Masson in inflamed hemorrhoid in 1923 and then it was also calledMasson tumor [1]. Actually, it is a benign exuberant proliferation of endothelial cells in the background of an organized thrombosis probably in response to endothelial basic growth factors [1, 2]. It is often associated with an underlying vascular lesion like hemangioma, pyogenic granuloma, or vascular malformations. IPEH usually occurs in skin and soft tissue. It has rarely been reported in spine and only ten cases (with consideration of the current case) have been reported so far [1, 3]. Spinal IPEH tends to occur in males with a male to female ratio of 4:1. All previous cases were adolescents and adults from 16 to 58 years and the present case is the first infant child with this lesion. The spinal cases usually happen in the thoracic spine. Rarely, lumbar and cervical spine involvement has also been observed as in this case. Back pain, numbness, paraparesis, paraplegia, and bladder dysfunction were the most common penetrations. Quadriparesis in the current patient is related to the upper location of the lesion. The duration of symptoms in IPEH cases ranged from one week to four months [3]. Surgical resection is the main treatment and the prognosis is good [4]. Finally, it should be emphasized that this unusual vascular pathology in the spine is benign and surgical removal of the lesion suffice for the treatment of compressive myelopathy. * Moeinadin Safavi [email protected]