Benign Tumors of the Spine To the Editor: With regard to the recent article by Thakur et al, 1 we wish to state the following consid- erations. Accurate diagnosis of spine he- mangiomas remains a challenge for physicians. Confusing terminology, lack of knowledge regarding lesion behavior, and poorly understood diagnostic criteria by orthopaedic surgeons are the rule. Despite dis- tinct clinical, radiologic, and histo- logic findings, vascular anomalies of the spine are often confused. This complicates both patient care and interpretation of the medical literature; at their cutaneous loca- tion, the most common misdiagno- sis in the management of bone vas- cular anomalies is the use of the term hemangioma to mean venous malformation. This misconception can easily lead to incorrect triaging and improper treatment. In 1996, the International Society for the Study of Vascular Anomalies (ISSVA) approved a classification system to establish a common lan- guage for the many different medi- cal specialists involved in the man- agement of these lesions. 2 A wide variety of vascular anom- alies are incorrectly referred to as “hemangiomas” in the medical lit- erature. The natural history of bone hemangiomas has been well documented. They are benign solid tumors that proliferate at a rapid rate in the first 6 months of life and involute before puberty. Disappear- ance occurs progressively, with these tumors being replaced by fi- broadipose tissue by 10 years of age. The histopathology of heman- gioma is characterized by cellular markers such as GLUT-1 (glucose transporter 1), which is found at all phases in hemangiomas and can be extremely helpful in differentiating them from other vascular tumors and malformations. After analysis of the “spine he- mangiomas” presented in the arti- cle by Thakur et al, 1 and according to the current ISSVA classification, we support the diagnosis of spine venous malformations. Although pain is the most common symptom of both spine hemangiomas and venous malfor- mations, treatment differs. 3,4 Phar- macologic angiogenesis inhibition with propranolol is the mainstay of hemangioma therapy. Intraosseous vascular obliteration and surgery are extremely useful in treating the much more common spine venous malformations. J.C. Lopez-Gutierrez, MD, PhD J. de las Heras, MD, PhD Madrid, Spain The Authors Respond: We appre- ciate the thoughtful letter by Dr. Lopez-Gutierrez and Dr. de las Heras regarding our recent paper. 1 Although GLUT-1 expression is used to distinguish pediatric he- mangiomas from vascular malfor- mations, we used the terminology in the IARC WHO Classification of Tumours, in which hemangioma refers to any of several benign vaso- formative neoplasms or develop- mental conditions of endothelial or- igin. 5 We agree that the term hemangioma may offer little clini- cal information on prognosis and optimal treatment and that the en- tire clinical picture must be care- fully assessed when treating a pa- tient with a vascular spinal tumor. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lopez- Gutierrez, Dr. de las Heras, and Dr. Thakur. http://dx.doi.org/10.5435/ JAAOS-21-02-65 Correspondence February 2013, Vol 21, No 2 65