Pseudomyogenic hemangioendothelioma of the thoracolumbar spine: A case-based review of a rare cause of vertebral collapse and neurological deficit.

BACKGROUND: Pseudomyogenic hemangioendothelioma (PMHE) is a rare, intermediate-grade vascular tumor. Spinal involvement with pathological fracture and neurological compromise is extremely rare. CASE PRESENTATION: A 24-year-old male presented with a T12 burst fracture, worsening back pain, bilateral lower-extremity paresthesia, and paraparesis. The tumor was hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences, with compression of the spinal cord. A posterior T12 vertebral column resection with pedicle screw fixation (T9-T11 and L1-L3), laminectomy, and anterior column reconstruction using an expandable mesh cage was performed. Gross total resection was achieved. Histopathological and immunohistochemical findings were consistent with PMHE. The two-year follow-up was uneventful. CLINICAL DISCUSSION: The diagnosis of spinal PMHE is challenging, as it may mimic other lytic bone tumors. Surgical decompression accompanied by circumferential reconstruction remains essential for neurological preservation. CONCLUSION: Aggressive spinal PMHE presenting with neurological deficits is rare. Posterior vertebral column resection with reconstruction may contribute to durable local control. Meticulous correlation of imaging, pathological, and clinical findings is required to establish an accurate diagnosis.