背景:血管内乳头状血管内皮瘤(IVPH)是以前报道的鼻腔良性病变,脖子,上肢,和乳房。横断面成像诊断可能很困难,诊断所需的组织病理学检查。IVPH导致腕管症状非常罕见。
方法:我们报告了一例37岁女性,掌右腕部肿块在5年内扩大。她注意到手腕和拇指麻木和刺痛,轻微的意外碰撞和手腕过度伸展加剧了。没有先前的创伤。在检查中,温和的温柔,活动肿块在右手腕的掌侧明显。磁共振成像(MRI)与对比显示分叶,主要是T2高强度,不均匀增强的肿块被认为是周围神经鞘瘤。患者选择手术切除肿块,组织病理学检查显示组织性血栓伴突出的乳头状内皮增生。在2个月的随访中,病人的手指和手腕有全方位的活动,在正中神经的分布中具有主观正常的感觉。
结论:腕管综合征,在极其罕见的场合,可以由IVPH引起。MRI结果可能与更常见的实体混淆。组织病理学确认对于结论性诊断仍然是必要的。
BACKGROUND: Intravascular papillary
hemangioendothelioma (IVPH) is a benign lesion previously reported in the nasal cavity, neck, upper extremities, and breast. Diagnosis with cross-sectional imaging can prove difficult, with histopathological examination necessary for diagnosis. IVPH resulting in carpal tunnel symptoms is quite rare.
METHODS: We report the case of a 37-year-old woman who presented with a radial, volar right wrist mass enlarging over the span of 5 years. She noted numbness and tingling in her wrist and thumb, exacerbated by minor accidental collisions and wrist hyperextension. There was no antecedent trauma. On examination, a mildly tender, mobile mass was evident at the volar aspect of the right wrist. Magnetic resonance imaging (MRI) with contrast demonstrated a lobulated, predominantly T2 hyperintense, heterogeneously enhancing mass thought to be a peripheral nerve sheath tumor. The patient elected for surgical excision of the mass, and the histopathological examination showed organizing thrombi with prominent papillary endothelial hyperplasia. At the 2-month follow-up, the patient had full range of motion of her fingers and wrist, with subjectively normal sensation in the distribution of the median nerve.
CONCLUSIONS: Carpal tunnel syndrome, in exceedingly rare occasions, can result from an IVPH. MRI findings may be confused with more common entities. Histopathological confirmation remains necessary for conclusive diagnosis.