Intraspinal lymphangioma of the lumbar spine confused with spinal synovial Cyst: A case report

Introduction: Lymphangiomas are benign tumors that result from the aberrant proliferation of lymphatic vessels. Although they are common in the head and neck, they can occur anywhere. Intraspinal lymphangiomas, however, are extremely rare, with only a few relevant cases have been reported in the literature. Herein, we present a case of intraspinal lymphangioma confused with a spinal synovial cyst in an 80-year-old male.Case Presentation: An 80-year-old male patient presented with severe lower back pain of 3-month duration radiating to the lower limbs. An MRI of the lumbar spine was done and showed a large right intra-spinal extradural cystic structure causing severe compression on the nerve roots. The imaging was suggestive of a spinal synovial cyst, and the patient was referred to orthopedic surgery for synovial cyst excision. The total resection of the mass was done successfully. Histopathologic examination revealed spinal lymphangioma. Postoperative evaluation showed stable vital signs, normal physical exam findings, and marked improvement of the patient’s lower back and radicular pain. He was followed up for 3 months without any reported complications or adverse events. Discussion: Due to the wide spectrum of pre-operative differential diagnoses for lymphangiomas, a definite pre-operative diagnosis is extremely difficult; thus, histopathologic assessment is the sole specific method for their diagnosis. Conclusion: This case demonstrates how spinal synovial cysts are an important differential for lymphangiomas in patients presenting with intraspinal extradural lesions.