Lumbar Extradural Angiolipoma: Clinical Presentation and Management

Abstract

Angiolipomas are rare primary benign tumors that can arise in the epidural canal and cause stenosis. Of the few cases of spinal angiolipomas described, most lesions have been located in the thoracic spine, and presentation of angiolipoma in the lumbar spine is very rare. The surgical management of a 39-year-old morbidly obese woman with angiolipoma that caused stenosis with neurogenic claudication and urinary changes is described. The lesion spanned L1-L2 and surgical management consisted of T12-L2 laminectomy and en-bloc resection of the lesion. During the latest follow-up, four years after the surgery, the patient's neurological symptoms showed improvement and there was no recurrence.

Keywords: angiolipoma; benign; extradural; lumbar spine; primary spine tumor.

Figure 1. Imaging Findings

(A) Sagittal T2 weighted MRI demonstrating the epidural lesion dorsal to the thecal sac spanning L1-L2 (arrow), (B) Axial T2 weighted MRI demonstrating the severe compression of the thecal sac and nerve roots (arrow), (C) Sagittal T2 weighted MRI demonstrating the hyperintense lesion (arrow),

Figure 2. Intra-operative findings

(A) Intraoperative image demonstrating the lesion (box) compression on the thecal sac. (B) The lesion that was resected en-bloc

Figure 3. Histology findings

(A) 4 x magnification and (B) 10 x magnification, hematoxylin and eosin-stained sections of the extradural lesion demonstrate a mixture of mature adipose tissue (open arrow) and variably sized, medium to small-caliber blood vessels (solid arrow). The adipocytes did not demonstrate cytological atypia. The vessels did not demonstrate cytological atypia and no mitotic figures were seen.