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. 2015 Dec 2:9:67.
doi: 10.14444/2067. eCollection 2015.

Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature

Mario Benvenutti-Regato  1 , Rafael De la Garza-Ramos  1 , Enrique Caro-Osorio  1
Affiliations

Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature

Mario Benvenutti-Regato et al. Int J Spine Surg. .

Abstract

Background: Spinal angiolipomas (SALs) are uncommon benign lesions that may present insidiously with back pain or acutely with weakness due to tumor bleeding/thrombosis. Given their rarity, these lesions are often overlooked in the differential diagnosis of epidural masses. The purpose of this article is to report the case of an epidural SAL and to conduct a literature review on the topic.

Methods: A case report and review of the literature using the PubMed/Medline databases. All case reports and case series were reviewed up to June 2015.

Results: A 65-year old female presented with neurogenic claudication and magnetic resonance imaging (MRI) revealed lumbar spinal stenosis. Following decompressive surgery, she experienced symptom resolution, but three months postoperatively she presented to the emergency department with acute paraparesis. A thoracic MRI revealed a lesion located between T8 and T10 causing severe spinal cord compression. Following emergent laminectomy and en bloc resection, the patient regained function and the lesion was diagnosed as SAL. Our literature review revealed 178 reported cases, with a female and thoracic predominance. The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome.

Conclusion: Spinal angiolipomas are uncommon spinal tumors. However, they may be treated as any other space-occupying lesion, and surgical resection allows for complete symptom recovery in most patients.

Keywords: epidural spinal angiolipoma; spinal angiolipoma; spinal tumor; spine surgery.

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Figures

Fig. 1
Fig. 1
Magnetic resonance image showing lumbar spinal stenosis. Sagittal (A) and axial (B) T2-weighted images showing lumbar spinal stenosis at L4/L5 secondary to ligamentum flavum hypertrophy and bilateral facet arthropathy. Sagittal (C) and axial (D) T2-weighted images showing foraminal stenosis on the left secondary to facet arthropathy at L5/S1.
Fig. 2
Fig. 2
Magnetic resonance image showing an epidural lesion extending from T8 – T10. Sagittal (A) and axial (B) T1-weighted images showing the dumbbell-shaped hyperintense lesion extending multiple levels and through the foramen at T9/T10. Additionally, the lesion shows hypointense regions, corresponding to the vascular component of the tumor. Sagittal (C) and axial (D) T2-weighted images showing severe spinal stenosis with spinal cord compression.
Fig. 3
Fig. 3
Intraoperative photographs showing a reddish-brown lesion overlying the thecal sac (Left) which was removed en bloc following laminectomy (Right).
Fig. 4
Fig. 4
Tumor specimen consisting of a soft, reddish-brown mass (Left). Histological slide showing mature adipocytes and blood vessels of various sizes, some filled with thrombin (Right).
See this image and copyright information in PMC

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