Spinal extradural angiolipoma: report of two cases and review of the literature

Abstract

Spinal angiolipomas are benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04-1.2% of all spinal tumors. We report two cases of lumbar extradural angiolipoma and review previously reported cases. We found 118 cases of spinal epidural angiolipoma (70 females and 48 males; age range 1.5-85 years, mean 44.03) spanning from 1890 to 2006. Prior to diagnosis 40.6% of the patients had weakness of the lower limbs. The interval between the initial symptoms and tumor diagnosis ranged from 1 day to 17 years (mean 20.2 months). Except for four cases diagnosed at autopsy, 109 patients underwent surgery and gross-total resection was performed in 79 cases (72.4%). Spinal angiolipomas are tumors containing angiomatous and lipomatous tissue, predominantly located in the mid-thoracic region. All angiolipomas show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images and most lesions enhance with gadolinium administration. The treatment for spinal extradural angiolipomas is total surgical resection and no adjuvant therapy should be administered.

Fig. 1

Preoperative sagittal MRI T1-weighted image: a (TR 720, TE 80); b (TR 462, TE 80) showing a mixed epidural mass at L5–S1 level

Fig. 2

Preoperative sagittal MRI T1-weighted image (TR 560, TE 14) (a), T2-weighted image (TR 400, TE 15); (b) showing an L5–S1 extradural slightly inhomogeneous epidural mass (arrows). Mild posterior protrusion L5–S1 disc

Fig. 3

The lesion contained mature adipocytes and small-medium caliber blood vessels indicative of angiolipoma (H&E ×80) (Case 1)