Masson’s tumor of the thoracic spine: a rare cause of slowly progressive paraplegia
Abstract
Introduction: Intravascular papillary endothelial hyperplasia is an unusual reactive proliferation of endothelial cells around an organized thrombus, which occurs either in a dilated blood vessel, hematoma, or pre-existing vascular lesion. These tumors rarely affect the central nervous system. It was initially described by Pierre Masson in 1923, only to later encounter numerous criticisms of the name itself, and in the context of the histological structure of the lesion. Symptoms depend on the localization of the process itself. Localization in the central nervous system is limited to the intracranial space. However, localization in the spinal canal is extremely rare, and so far there are only a few clinical cases described in the literature.
Case presentation: A 67-year-old female patient was examined neurologically initially due to bilateral weakness of the lower extremities, accompanied by a feeling of pain and muscle tension, dominantly in the upper legs, more to the right. The complaints were present a year ago, and before that period the patient was in a stable state of health. Due to severe neurological deficit and the need for detailed exploration, the patient was hospitalized. A multidisciplinary diagnosis was performed, which showed the localization of the pathological process in the thoracic 5-6 region of the spinal column. The differential diagnosis was thought to be in the direction of metastatic change of lung, breast or pelvic region malignancy. Decompression surgery was performed, and it was already clear from the ex tempore findings that it was not a metastasis. Definitive PH finding proved Masson tumor. After the operation, the neurological defect recovered.
Conclusion: Neurological symptoms are often the result of primary somatic diseases. However, with a careful examination, a complete and complementary assessment of the patient, we can get to the real cause. Masson's tumor, although rarely localized in the spinal canal, is curable if adequately diagnosed and treated. The significance lies in the domain of differential diagnostics, because the initially presented symptoms may resemble numerous neurological or systemic diseases, which requires the clinician to be continuously aware of such rare pathological processes.
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