BACKGROUND Although epithelioid hemangiomas involving bone have been described in previous case reports and case series, the effects of radiation therapy on vertebral epithelioid hemangioma has not been fully reported. Here we provide a case report of tumor response to radiation therapy in a young adult with a large epithelioid hemangioma involving the fourth lumbar vertebrae. CASE PRESENTATION A 27-year-old Latino man with a past medical history of type 1 diabetes and a 3-year history of low back pain presented to a hospital emergency department following acute worsening of back pain. On transfer to our tertiary medical center, he described the pain as "shock-like" which originated at the lateral aspect of his right hip and radiated down to his right knee. Paresthesia was also reported along the medial aspect of his lower right leg. Imaging included a computed tomography scan and magnetic resonance imaging which revealed fourth lumbar and right iliac lytic bone lesions. Image-guided biopsies of the lytic lesions were consistent with a diagnosis of epithelioid hemangioma and radiation therapy was recommended as the primary treatment. Our patient's low back and leg pain were initially managed with acetaminophen, oxycodone, pregabalin, and lidocaine patch 5%. He noted improvement in pain after his third fraction of radiation. Pain intensity continued to decline and oxycodone was discontinued. CONCLUSIONS This case report demonstrates an unusual etiology of back and leg pain in a young man and elucidates the palliative effects of radiation therapy for epithelioid hemangioma involving the lumbar spine.

中文翻译：

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放射治疗腰椎上皮样血管瘤的一例报告。

背景技术尽管在先前的病例报告和病例系列中已经描述了涉及骨的上皮样血管瘤，但是尚未完全报道放射治疗对椎骨上皮样血管瘤的作用。在这里，我们提供了一个在涉及第四腰椎的大型上皮样血管瘤的年轻成人中，对放射治疗产生的肿瘤反应的病例报告。病例介绍一名27岁的拉丁美洲人，曾有1型糖尿病的病史，并且有3年的腰痛史，在腰背疼痛严重加重后被送往医院急诊科。在转移到我们的第三级医疗中心时，他将疼痛描述为“类似休克的疼痛”，起源于右髋关节的外侧并向下辐射到右膝。右下腿内侧也有感觉异常。影像学包括计算机断层扫描和磁共振成像，显示出第四腰椎和右lytic骨溶解性骨病变。溶血性病变的影像引导活检与上皮样血管瘤的诊断一致，因此推荐放射治疗作为主要治疗方法。该患者的下背部和腿部疼痛最初采用对乙酰氨基酚，羟考酮，普瑞巴林和5％利多卡因贴剂治疗。他注意到放射的第三部分后疼痛有所改善。疼痛强度持续下降，并停止使用羟考酮。结论该病例报告显示了年轻人背部和腿部疼痛的不寻常病因，并阐明了放射治疗涉及腰椎的上皮样血管瘤的姑息作用。