gms | German Medical Science

Objective: Lesions of the clivus may be challenging in terms of diagnosis and treatment. The differential diagnosis includes chordoma, chondrosarcoma, osteosarcoma, osteoblastoma, multiple myeloma, fibrous dysplasia, eosinophilic granuloma, aneurysmal bone cysts, meningioma and bone metastasis. We present the exceedingly rare case of a patient with primary intraosseus hemangioma (PICH) of the clivus.

Method: Presentation of a rare case and review of the literature

Results: A 54-year-old patient presented with swallowing difficulties and neck pain. Laryngoscopy revealed normal vocal cord morphology and function. Magnetic resonance imaging (MRI) of the cervical spine was normal but was suspective of cystic transformation of the clivus. MRI of the neurocranium revealed an extensive tumor of the clivus. Microsurgical transnasal-transsphenoidal biopsy finally revealed cavernous hemangioma. The patient was followed by clinical examination and MRI every three months. The clinical course was characterized by episodes of swallowing difficulties with spontaneous resolution.

Conclusions: We present a rare case of extensive clivus hemangioma in a 54-year-old patient with unspecific symptoms of neck pain and difficulties swallowing. Biopsy is essential to define the nature of the lesion. Clinical and MRI follow-up is appropriate, at least in the short-term.