Dorsal epidural "Spindle Cell Lipoma" in a pregnant female

Abstract

Background: Spindle cell lipoma (SCL) constitutes just 1.5% of all lipomatous tumors. They typically occur in the upper back and shoulders. Here, we report a 37-year-old female presenting with a SCL in the dorsal epidural thoracic spine, during her 9^th month of pregnancy.

Case description: A 37-year-old female presented with a subacute (2 months) progressive paraparesis during her ^9th month of pregnancy. The MR showed a dorsal epidural mass at the D8 level. Following a cesarean section, the patient underwent a laminectomy for tumor excision. Microscopically, the lesion proved to be a SCL. At 5-year follow-up, there was no tumor recurrence.

Conclusion: SCL represents a variant of benign lipomas that may occur in the dorsal thoracic spine. Gross total excision may be followed by a benign clinical course without recurrence or malignant degeneration. Very atypical SCLs need closer follow-up to avoid the misdiagnosis of liposarcoma.

Keywords: Epidural space; Liposarcoma; Neurosurgery; Spindle cell lipoma; Spine.

Figure 1:

Sagittal T2-weighed image (left) and axial T1-weighed image after gadolinium administration (right), showing the D7–D9 extension of the mass and the spinal cord compression. At the D8 level, it is evident the invasion of the right peripleural space through the right conjugation canal.

Figure 2:

Surgical exposure after a D7–D9 laminectomy and D8 right partial costotrasversectomy: The lesion fills the posterior epidural space.

Figure 3:

The two macroscopically different portions of the mass are shown: No significant differences were found at histological examination instead.

Figure 4:

Microscopical aspect of the tumor: Oval and spindle cells are embedded in a myxoid stroma within lobules of mature adipose tissue.

Figure 5:

Postoperative MRI: the total mass removal corresponded to a good dural sac re-expansion.