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King KA, Tsao T, Abdulrahim A, Hildenbrand A. A Case of Thoracic Epidural Angiolipoma Causing Severe Spinal Cord Compression With Neurologic Manifestations. Cureus 2023; 15:e45305. [PMID: 37720116 PMCID: PMC10503948 DOI: 10.7759/cureus.45305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/19/2023] Open
Abstract
A spinal epidural angiolipoma is a rare, benign tumor of adipocytes and blood vessels that accounts only for a small percentage of all spinal axis tumors. We report a case of a 44-year-old male who presented with three months of progressive decreased sensation and strength from about six cm above the umbilicus down to his feet bilaterally. He presented to the emergency room when he could no longer walk. He also had neurogenic urinary retention and likely neurogenic constipation. Physical exam was notable for decreased sensation, decreased strength, and increased patellar reflexes bilaterally. MRI of the thoracic spine showed a posterior epidural mass that spanned from T2 to T3, measuring 1.2 x 1.7 x 4.3 cm, and severely compressed the spinal cord posteriorly. The patient underwent an urgent laminectomy for decompression and mass resection. Pathology was consistent with an angiolipoma. Postoperatively, he experienced a drastic improvement in strength and gross motor skills. The sensation had a partial return following surgery and continued to improve over the hospital stay. In general, the literature reports significant symptomatic improvement in patients with spinal epidural angiolipomas after surgical resection.
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Affiliation(s)
- Kali A King
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Tiffany Tsao
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ahmed Abdulrahim
- Pathology and Laboratory Medicine, Creighton University School of Medicine, Omaha, USA
| | - Alec Hildenbrand
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
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CT and MRI presentation of intradural epidural angiolipoma of the thoracic spinal canal (with a case report). Radiol Case Rep 2023; 18:1721-1726. [PMID: 36895895 PMCID: PMC9989297 DOI: 10.1016/j.radcr.2023.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
Epidural angiolipoma is a rare benign tumor consisting of mature adipocytes, blood sinuses, capillaries, and small blood vessels. It constitutes about 0.04%-1.2% of spinal axis tumors and about 2%-3% of extradural spinal tumors. We report a case of thoracic epidural angiolipoma and review the literature. We describe a 42-year-old woman who had weakness and numbness in her lower extremities prior to diagnosis and had an onset of approximately 10 months. The patient was misdiagnosed as schwannoma on preoperative imaging, possibly because neurogenous tumor is the most common intramedullary subdural tumor, and the lesion grew into bilateral intervertebral foramina. However, the lesion demonstrated high signal on the T2-weighted and T2 fat suppression sequences, and the linear low signal at the lesion edge was ignored, leading to misdiagnosis. The patient underwent posterior thoracic 4-6 laminectomy, pathectomy, and spinal decompression/vertebroplasty under general anesthesia. The final pathologic diagnosis was intradural epidural angiolipoma of the thoracic vertebra. Spinal epidural angiolipoma is a rare benign tumor that occurs frequently in middle-aged women and is mostly located on the dorsal side of the thoracic spinal canal. Magnetic resonance imaging findings of spinal epidural angiolipoma depend on the ratio of fat to blood vessels. Most angiolipomas show equal or high signal on T1-weighted images and high intensity on T2-weighted images, with significant enhancement after injection of gadolinium. The treatment of spinal epidural angiolipoma is complete surgical resection with good prognosis.
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Wang K, Shi L, Su Y, Wang H, Liu L. Clinical features and surgical outcomes of spinal epidural angiolipomas. Acta Neurol Belg 2023; 123:115-120. [PMID: 33948901 DOI: 10.1007/s13760-021-01689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
To discuss the clinical features and surgical outcomes of spinal epidural angiolipomas. We retrospectively analyzed the medical records of patients with spinal epidural angiolipomas who were performed microsurgery between January 2003 and December 2017. The diagnosis of spinal angiolipomas was based on pathological criteria. Modified McCormick classification was applied to evaluate neurological function. There were 11 females and 9 males with ages ranged from 38 to 74 years. Fourteen lesions were located in the thoracic region, 4 in the lumbar, 1 in the lumbosacral, and 1 in the thoracolumbar region. Patients presented with nonspecific symptoms and the duration of symptoms ranged from 1 to 168 months with a mean 21.3 months. 11 cases exhibited isointense on T1-weighted imaging(T1WI) and hyperintense on T2-weighted imaging(T2WI). The other 9 cases exhibited hyperintense on T1WI and T2WI imaging. Gross total resection (GTR) was performed in 19 patients, and subtotal resection (STR) was performed in 1 patient. Postoperatively, all patients showed a recovery or improvement of neurological functions except the STR patient. There was no recurrence or regrowth of the residual lesions observed on magnetic resonance images (MRI). Usually, spinal epidural angiolipomas have two types of MRI manifestations depending on the ratio of fat to vessels. Total resection of spinal epidural angiolipoma is possible regardless of it is infiltrative or not. Postoperative radiotherapy is not recommended for subtotal resection patients. A favorable functional outcome can be expected if the patient performed early surgery.
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Affiliation(s)
- Keda Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China.
| | - Hanbin Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Longqi Liu
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
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Laeke T, Yibeltal M, Kwon YD. Thoracic spinal angiomyolipoma: case report from an Ethiopian neurosurgical teaching hospital. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22216. [PMID: 36471580 PMCID: PMC9724004 DOI: 10.3171/case22216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Angiomyolipoma (AML) of the spine is a rare benign neoplasm (accounting for 0.14%-1.2% of all spine tumors) that is often described along with angiolipoma because of their similarities. They occur almost exclusively in the extradural space, with the thoracic spine being the commonest level. OBSERVATIONS The authors present the clinical presentation, diagnosis, and treatment of an extremely rare case of thoracic spine AML in a 47-year-old male patient. The patient underwent laminectomy and gross total resection of the tumor and had an excellent immediate postoperative neurological recovery and long-term functional neurological outcome. LESSONS It is always wise to consider rare benign spinal epidural neoplasms such as spinal AMLs in the differential diagnosis of spinal epidural mass, despite metastasis being the commonest epidural tumor with variable modes of treatment, because the management of benign spinal epidural masses such as spine AML is always surgical and associated with an excellent long-term outcome.
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Affiliation(s)
- Tsegazeab Laeke
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, Addis Ababa, Ethiopia; and
| | - Mestet Yibeltal
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, Addis Ababa, Ethiopia; and
| | - Young Dae Kwon
- Department of Surgery, Neurosurgery Unit, Myungsung Christian Medical Center, Addis Ababa, Ethiopia
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Somrani K, Ammar H, Gargouri F, Mansouri N, Yedeas MD, Chkili R. A rare case report of sacral epidural angiolipoma: Diagnosis and treatment. Surg Neurol Int 2022; 13:38. [PMID: 35242404 PMCID: PMC8888184 DOI: 10.25259/sni_1115_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/17/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Spinal angiolipomas are rare benign tumors composed of mature adipose tissue and anomalous vascular channels. The sacral localization is extremely rare. To the best of our knowledge, there have been only two cases reported in the literature. Herein, we present an additional case of sacral angiolipoma.
Case Description:
We present a case of a 54-year-old woman who presented with the right lumbosciatica and distal crural weakness. Spinal MRI showed an epidural lesion at the level of L5-S1 extending to the first right sacral foramen. The patient had total resection of the tumor and the histological study concluded to an angiolipoma. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence.
Conclusion:
Despite the rarity of sacral localization in angiolipomas, it is a diagnosis to be considered in the case of an epidural tumor with foraminal extension. Magnetic resonance imaging is important for detecting and characterizing spinal angiolipomas despite diagnosis is not always obvious. After surgical removal, the functional prognosis is generally favorable.
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Affiliation(s)
- Kaouther Somrani
- Department of Neurosurgery, Military Hospital of Instruction of Tunis, Tunis, Tunisia
| | - Hichem Ammar
- Department of Neurosurgery, Military Hospital of Instruction of Tunis, Tunis, Tunisia
| | - Faten Gargouri
- Department of Pathology, Military Hospital of Instruction of Tunis, Tunis, Tunisia
| | - Nada Mansouri
- Department of Pathology, Military Hospital of Instruction of Tunis, Tunis, Tunisia
| | | | - Ridha Chkili
- Department of Neurosurgery, Military Hospital of Instruction of Tunis, Tunis, Tunisia
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Umana GE, Visocchi M, Roca E, Passanisi M, Fricia M, Tranchina MG, Tomasi SO, Nicoletti GF, Cicero S, Scalia G. Thoracic Spinal Angiolipomas: A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:161-172. [PMID: 34929751 DOI: 10.1055/s-0041-1739217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spinal angiolipomas (SAs) are rare, benign tumors, representing 0.0004 to 1.2% of angiolipomas, usually located at the extradural and posterior thoracic level, with multimetameric extension. METHODS A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The authors searched on PubMed and Scopus databases for published articles with the Mesh term "spinal angiolipoma" and pertinent associations. Language restriction to English papers was applied. The authors also reported three emblematic cases of patients who underwent surgical resection of spindle-shaped (type IA) and dumbbell-shaped (type II) SAs between 2014 and 2020. RESULTS Of the 256 retrieved articles, 33 were included in the meta-analysis. These 33 studies, together with our 3 reported cases, included a total of 60 patients, 36 females (60%) and 24 males (40%), with a mean age of 53.12 ± 12.82 years (range: 12-77 years).T5 was the most represented level (22 patients). Usually, the localization of SA was extradural, with 53 patients suffering from spindle-shaped type IA SA (88.3%) and 7 patients from dumbbell-shaped type II SA (11.6%). Almost all patients underwent laminectomy (78.3%) and presented a full recovery of motor deficits (85%). Gross total removal (GTR) was performed in 93.3% of patients. The mean follow-up was of 22.71 ± 21.45 months (range: 2-80 months). There was no documented recurrence at follow-up magnetic resonance imaging in any of the patients. CONCLUSIONS SAs are rare, benign tumors with a great vascular component that presents a favorable outcome. GTR is the gold standard treatment and usually an adjuvant therapy is not required. Even infiltrative lesions, which are more complex, can be treated successfully with a good prognosis. Dumbbell-shaped SAs must be differentiated from schwannomas and meningiomas, and require different surgical techniques, given the profuse bleeding associated with the attempt of debulking. En block resection is the key to treat these common benign tumors with acceptable blood loss.
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Affiliation(s)
| | - Massimiliano Visocchi
- Department of Neurosurgery, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy.,Catholic University of the Sacred Heart Rome Campus, Roma, Italy
| | - Elena Roca
- Department of Neurosurgery, Head and Neck Surgery, Poliambulanza Foundation Hospitals, Brescia, Lombardia, Italy
| | - Maurizio Passanisi
- Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | | | | | | | | | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
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Zhang X, Dong S, Wang G, Zhang H, Wang JJ, Wang G. Spinal Angiolipomas : Clinical Characteristics, Surgical Strategies and Prognosis. J Korean Neurosurg Soc 2021; 65:49-56. [PMID: 34823274 PMCID: PMC8752894 DOI: 10.3340/jkns.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Angiolipomas are usually found in the subcutaneous tissue of the trunk and limbs. Spinal angiolipomas (SALs) are uncommon and have rarely been reported. We report a series of nine SALs patients who received surgical treatment in our department. To summarize the clinical characteristics of SALs, propose our surgical strategies, and evaluate the effects of the operation.
Methods This was a retrospective review of nine SALs patients who received surgical treatment from August 2015 to March 2020. Total or subtotal resection was determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. The outcomes were assessed based on the modified Japanese Orthopaedic Association (mJOA) scoring system utilized before surgery and at various follow-up points.
Results Among the nine patients, the mean mJOA score before surgery was 6.6±2.3, compared with 10.1±1.1 at the last follow-up time point (33.4±11.8 months). All patients achieved good outcomes, even in cases of subtotal resection.
Conclusion Early surgical resection of SALs is recommended, and the specific procedures should be determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. Most of the patients had a good prognosis, even in cases of subtotal resection.
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Affiliation(s)
- Xiaolei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Benhayoun O, Makhchoune M, Jehri A, Yassine Haouas M, Hilmani S, Lakhdar A. Spinal extradural angiolipomas: A case report. Ann Med Surg (Lond) 2021; 65:102289. [PMID: 33912345 PMCID: PMC8066406 DOI: 10.1016/j.amsu.2021.102289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Angiolipoma are benign tumors composed of mature adipocytes ad mixed with abnormal vascular elements. It reportedly accounts for 0.1–0.5% of all spinal axis tumors in adults and is extremely rare in children. This article describes a case of spinal extradural angiolipoma in a 35-year-old man, who presented with paraplegia and sphincter disorders, the MRI showed extradural spinal lesions at the level of T7 to T10, that squeezed the spinal cord. We attained total resection without any further neurological complication. The diagnosis of SEALs initially can be challenging radiologically since they may imitate other spinal lesions. The gold standard treatment modality should always be surgery, however in some cases, total resection can not be done. This paper presents a 35-year-old man complaining for 1 months a numbness and lowerlimbs heaviness. The neurological examination revealed paraplegia with a muscle power was 2/5. However, in lower limbs, the deep tendon reflexes were absent, walking was impossible also without any sensitive disorder. MRI revealed T7-T10 extradural spinal lesion. The tumor appeared as an hyperintense on T1 and T2-weighted images, and as heterogeneous on STIR. Total resection after dissecting the tissue around the tumor. The histopathological examination of the specimens obtained, showed that the lesion was made up of fatty tissue and angioma-like tissue. SAL is a rare benign tumor and considered as a specific clinico-pathological entity. MRI is considered to be the “gold standard” in diagnosing SAL and surgery appears to be the treatment of choice.
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Affiliation(s)
- Othman Benhayoun
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Marouane Makhchoune
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Abdelhamid Jehri
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | | | - Said Hilmani
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
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Yang T, Niu C. Microsurgical treatment for spinal epidural angiolipomas. Acta Neurol Belg 2021; 121:421-427. [PMID: 31309454 DOI: 10.1007/s13760-019-01192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
Spinal epidural angiolipomas are rare lesions composed of mature lipomatous and angiomatous elements. In this paper, the authors review a surgical series of ten patients with epidural angiolipomas. All patients had performed preoperative and postoperative magnetic resonance imaging. The diagnosis of angiolipoma was based on pathology. All the follow-up data were obtained during office visits. There were 5 males and 5 females with a mean age of 53.6 years. One tumor was located in the cervicothoracic, six in the thoracic, and three in the lumbar spine. The most common symptom was progressive motor deficit. Gross total resection of the tumor was achieved in nine cases, and subtotal resection was obtained in one case. No recurrence or regrowth of the residual tumor was observed during a follow-up period of 50.8 months. At the last follow-up, 90% of patients experienced improvement in the neurological function. Epidural angiolipomas are benign but clinically progressive lesions. Early surgery should be performed to prevent irreversible neurological deficits. Postoperative radiotherapy is not recommended. The risk of long-term recurrence/regrowth of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - ChaoShi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.
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Bond JD, Zhang M. Clinical Anatomy of the Extradural Neural Axis Compartment: A Literature Review. World Neurosurg 2020; 142:425-433. [PMID: 32711147 PMCID: PMC7375305 DOI: 10.1016/j.wneu.2020.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The extradural neural axis compartment (EDNAC) is an adipovenous zone located between the meningeal and endosteal layers of the dura and has been minimally investigated. It runs along the neuraxis from the orbits down to the coccyx and contains fat, valveless veins, arteries, and nerves. In the present review, we have outlined the current knowledge regarding the structural and functional significance of the EDNAC. METHODS We performed a narrative review of the reported EDNAC data. RESULTS The EDNAC can be organized into 4 regional enlargements along its length: the orbital, lateral sellar, clival, and spinal segments, with a lateral sellar orbital junction linking the orbital and lateral sellar segments. The orbital EDNAC facilitates the movement of the eyeball and elsewhere allows limited motility for the meningeal dura. The major nerves and vessels are cushioned and supported by the EDNAC. Increased intra-abdominal pressure will also be conveyed along the spinal EDNAC, causing increased venous pressure in the spine and cranium. From a pathological perspective, the EDNAC functions as a low-resistance, extradural passageway that might facilitate tumor encroachment and expansion. CONCLUSIONS Clinicians should be aware of the extent and significance of the EDNAC, which could affect skull base and spine surgery, and have an understanding of the tumor spread pathways and growth patterns. Comparatively little research has focused on the EDNAC since its initial description. Therefore, future investigations are required to provide more information on this underappreciated component of neuraxial anatomy.
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Affiliation(s)
- Jacob D Bond
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Dundin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, Anhui Medical University, Hefei, China.
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Cheng Y, Lu K, Jiang H. Epidural angiolipoma with concomitant intradural extramedullary capillary hemangioma at the same spinal level: A case report. Oncol Lett 2020; 20:209-214. [PMID: 32565948 PMCID: PMC7286118 DOI: 10.3892/ol.2020.11559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Spinal epidural angiolipomas (SALs) and spinal intradural extramedullary capillary hemangiomas (SIECHs) are both types of rare benign tumor, and their pathogeneses appear to be associated. The present report is, to the best of our knowledge, the first case of spinal angiolipoma and intradural extramedullary capillary hemangioma occurring at the same spinal level. A 54 year-old male patient experienced two operations within four months due to the occurrence of SAL and one SIECH at the T3 level presenting with sudden paraplegia. Although the co-occurrence of SAL and SIECH at the same spinal level is an extremely rare condition, omitting the intradural tumor may be averted via scrutiny of preoperative images.
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Affiliation(s)
- Yongquan Cheng
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Kaiwu Lu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hui Jiang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Jaiswal PA, Divakar G, Krishnakumar K, Karthikayan A, Sawakare Y, Mhatre R, Abraham M. Spinal angiolipoma-a rare but reversible cause of paraplegia in a child. Childs Nerv Syst 2020; 36:1121-1125. [PMID: 32052158 DOI: 10.1007/s00381-020-04542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Spinal angiolipomas are benign spinal epidural tumors consisting of mature fat cells with angiomatous components. These tumors are rare in children and there are no definite management guidelines. METHOD To the best of our knowledge, only five cases of spinal angiolipomas have been reported in children below 12 years. This article discusses the presentation, diagnostics, and surgical tips for the management of a case of spinal angiolipoma. RESULT In this paper, we present a one and half-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal angiolipoma and underscore the importance of early surgery in a benign disease for a good outcome. CONCLUSION Overall neurological recovery and prognosis following timely intervention for spinal angiolipomas are good.
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Affiliation(s)
- Palak A Jaiswal
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
| | - K Krishnakumar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Arunkumar Karthikayan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Yogesh Sawakare
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Radhika Mhatre
- Department of Pathology, National Institute of Mental Health and Neurosciences (NIMHANS), Benguluru, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
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Iampreechakul P, Tangviriyapaiboon T, Liengudom A, Lertbutsayanukul P, Thammachantha S, Siriwimonmas S. Sacral Extradural Angiolipoma Associated with Tight Filum Terminale and Spina Bifida Coexisting with Spinal Arteriovenous Fistula. World Neurosurg 2020; 140:37-45. [PMID: 32407913 DOI: 10.1016/j.wneu.2020.04.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spinal arteriovenous fistula (AVF) may rarely associate with spinal dysraphism, that is, tethered spinal cord and spinal intradural lipoma. Spinal extradural angiolipoma coexisting with spinal AVF has not been reported in the literature. We reported an extremely rare case of sacral angiolipoma associated with tight filum terminale and sacral spina bifida coexisting with spinal AVF within this tumor. CASE DESCRIPTION A 55-year-old women presented with progressive myelopathy for 10 months. She had a painless, slow-growing mass at her left buttock since birth. Magnetic resonance imaging of the lumbosacral spine showed an extradural mass at the level of S3-S4, extending from the spinal canal through the spina bifida to the subcutaneous fat of the left buttock. There was a low conus medullaris at S2. Magnetic resonance imaging of the thoracic spine disclosed venous congestion with tortuous intradural flow voids along both ventral and dorsal surfaces of the spinal cord. Magnetic resonance angiography and spinal angiography revealed a hypervascular mass at the sacral level and associated arteriovenous shunt with cranial drainage into an enlarged medullary vein. Due to an infected pressure sore on the mass, endovascular treatment was initially performed with minimal recovery. Six months after complete healing of her infected pressure ulcer, the patient underwent surgical removal of extradural mass containing the AVF, and subsequent release of the tight filum. Histologic findings were consistent with angiolipoma. CONCLUSIONS Sacral extradural angiolipoma in the present case may be congenital in origin with development of an acquired spinal AVF within the tumor.
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Affiliation(s)
| | | | - Anusak Liengudom
- Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
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14
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Zhang Y, Yang J, Xu A, Li D, Yang G. A rare case of scrotal angiolipoma and the literature review. Urol Case Rep 2020; 32:101217. [PMID: 32382509 PMCID: PMC7200305 DOI: 10.1016/j.eucr.2020.101217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Angiolipoma has been reported in many cases, which often occurring subcutaneously in the trunk and limbs. However, angiolipoma rarely occurs in the scrotum. In order to better understand its biological characteristics, clinical features and prognosis, in this case, a 41-year-old male with painful angiolipoma in the scrotum was reported.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No 1111 Xianxia Rd, Shanghai, 200336, China
| | - Jing Yang
- Department of Pathology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No 1111 Xianxia Rd, Shanghai, 200336, China
| | - An Xu
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No 1111 Xianxia Rd, Shanghai, 200336, China
| | - Dong Li
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No 1111 Xianxia Rd, Shanghai, 200336, China
| | - Ganggang Yang
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No 1111 Xianxia Rd, Shanghai, 200336, China
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15
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Spinal angiolipoma: Presentation of two cases and review of the literature for the years 2012–2017. Neurocirugia (Astur) 2020; 31:76-86. [DOI: 10.1016/j.neucir.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/25/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
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16
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Zhang X, Wang JJ, Guo Y, Dong S, Shi W, Wang G, Zhang H, Wang G. Sudden Aggravated Radicular Pain Caused by Hemorrhagic Spinal Angiolipomas After Back Massage. World Neurosurg 2019; 134:383-387. [PMID: 31733392 DOI: 10.1016/j.wneu.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal angiolipomas (SALs) are benign tumors that usually present a slow progressive spinal cord or radicular compression. Acute myelopathy or acute aggravated radicular syndrome are exceedingly rare. CASE DESCRIPTION The authors report an original case with sudden aggravated radicular pain caused by hemorrhagic SALs. A 54-year-old woman presented with a 2-month history of mild back pain, and the pain was significantly aggravated after a therapeutic back massage. Neurologic examination showed pain and hyperalgesia between T4 and T7 dermatome, from back to front, just like a band. Spinal magnetic resonance imaging (MRI) showed a dorsally located epidural lesion (T4-T6) and a small intratumoral hemorrhage at the lower part of the tumor. A bilateral T4-T6 laminectomy was performed to achieve total excision of the tumors. Histologic examination showed that the tumors were composed of mature adipose tissue and vascular tissue as angiolipomas. The postoperative course was uneventful with complete neurologic recovery 4 days after the surgery. MRI at 1-year follow-up indicated no recurrence. CONCLUSIONS SALs are unusual benign tumors that are composed of mature fatty tissue and abnormal blood vessels; sudden aggravated spinal cord or radicular compression syndrome is rare. MRI is the best choice in the diagnosis of SALs. Surgery may be performed in different ways depending on the type of SALs, and the prognosis is generally good.
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Affiliation(s)
- Xiaolei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - James Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Wei Shi
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China.
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17
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Spinal extradural angiolipomas: 7 new cases and review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Spinal angiolipomas in pregnancy: Natural history and surgical treatment. Clin Neurol Neurosurg 2019; 178:25-30. [DOI: 10.1016/j.clineuro.2019.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 12/23/2022]
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19
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Hemorrhagic Sudden Onset of Spinal Epidural Angiolipoma. Case Rep Orthop 2018; 2018:5231931. [PMID: 30057841 PMCID: PMC6051123 DOI: 10.1155/2018/5231931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/24/2018] [Indexed: 11/20/2022] Open
Abstract
Angiolipomas are relatively rare benign tumors. Spinal angiolipomas that generally induce slow progressive cord compression are most commonly found in the thoracic region. A 49-year-old female with obesity presented with a 1-week history of progressively worsening back pain, paresthesia of lower limbs, and gait disturbance. When thoracic magnetic resonance imaging (MRI) revealed a dorsal epidural mass at the Th5–Th8 level, the patient underwent a laminectomy for gross total excision of the lesion. Both mature fatty tissue and abnormal proliferating vascular elements with thin or expanded walls were observed in the resected tumor. Nonfiltrating spinal angiolipoma was diagnosed and confirmed by pathology. After the operation, sensory loss, numbness, and gait disturbance were improved following the disappearing severe back pain. Following examinations indicated the absence of recurrence within 1 year. The angiolipomas of the spine are rare causes of spinal cord compression that generally induce slow progressive cord compression, but sudden onset or rapid worsening of neurological deterioration is observed in hemorrhagic spinal angiolipoma.
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20
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Yang X, Richard SA, Lei C, Liu J, Huang S. Spinal extradural angiolipoma: a report of two cases and review of literature. JOURNAL OF SPINE SURGERY 2018; 4:490-495. [PMID: 30069550 DOI: 10.21037/jss.2018.06.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Spinal extradural angiolipomas (SEALs) are extremely extraordinary benign extradural lesions. They are infrequently encountered in normal clinical practice although several authors have report single cases or case series. We present two cases of SEAL which we successfully surgical resected with no further neurological deficits. Our cases comprise of a male and a female with ages ranging from 30 to 60 years. Their principal presenting complains were numbness and pain at the lower extremity with associated fecal and urinary incontinence. In all our cases, MRI revealed extradural spinal lesions that exerted compressive effect on the spinal cord. The male patient had an infiltrating type while the female had non-infiltrating type. We attained total resection in both cases without any further neurological complication. The diagnosis of SEALs initially can be challenging radiologically since they may mimic other spinal lesions. The gold standard treatment modality should always be surgery although total resection may not be achievable in some cases.
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Affiliation(s)
- Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Department of Immunology, Jiangsu University, Zhenjiang 212013, China.,Department of Surgery, Volta Regional Hospital, Ho, Ghana-West Africa
| | - Chuanfen Lei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
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21
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Yeo ED, Chung BM, Kim EJ, Kim WT. Infiltrating angiolipoma of the foot: magnetic resonance imaging features and review of the literature. Skeletal Radiol 2018; 47:859-864. [PMID: 29322209 DOI: 10.1007/s00256-017-2870-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/25/2017] [Accepted: 12/27/2017] [Indexed: 02/02/2023]
Abstract
Angiolipoma is a benign soft tissue tumor with two subtypes: non-infiltrating and infiltrating. Although histologically benign, infiltrating angiolipoma can invade surrounding structures. The foot is a very rare location for angiolipoma, with only four cases reported in the English literature, including one infiltrating type. Here, we report a very rare case of infiltrating angiolipoma of the foot with magnetic resonance imaging (MRI) and ultrasonography (US) findings. A 7-year-old boy presented with a slowly growing foot mass. MRI showed an unencapsulated mass involving the third web space extending to the foot dorsum and sole. The mass was isointense to subcutaneous fat and was mixed with internal T1 low-signal-intensity enhancing areas. On US, we observed a heterogeneously hypoechoic mass with internal vascularity. Imaging and clinical features of angiolipoma and the radiologic differential diagnoses of a fat-containing mass in the pediatric foot are reviewed here. When there is an ill-defined foot mass with a fat component and variable enhancing portions in a child, infiltrating angiolipoma should be included in the differential diagnosis along with other fat-containing tumors.
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Affiliation(s)
- Eui Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea
| | - Bo Mi Chung
- Department of Radiology, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea.
| | - Eun Ju Kim
- Department of Pathology, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea
| | - Wan Tae Kim
- Department of Radiology, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea
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22
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Epidural angiolipoma: A rare cause of spinal cord compression. Int J Surg Case Rep 2018; 45:72-76. [PMID: 29573600 PMCID: PMC6000995 DOI: 10.1016/j.ijscr.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 11/22/2022] Open
Abstract
Spinal epidural angiolipoma is a rare cause of progressive spinal cord compression. Magnetic resonance imaging is necessary for diagnosis. Total resection is the treatment of choice. Necessary precautions before and during surgery have to be taken (embolisation, transfusion). Prognosis after surgical management is excellent even at the stage of complete paraplegia.
Introduction Angiolipomas are benign, slow growing lesions, almost always located subcutaneously in the trunc or limbs. They are composed of mature lipocytes admixed with abnormal blood vessels. Spinal epidural angiolipoma are rare accounting for approximately 0.14–1.2% of all spinal axis tumors and 2–3% of epidural spinal tumors. Presentation of case We report the case of a 65 years-old-woman, presenting with complete paraplegia installed since 7 months. Magnetic resonance imaging (MRI) showed an epidural dorsal fatty mass. The patient recovered immediately after surgery. The pathological examination concluded to an angiolipoma. Discussion Angiolipoma patients most commonly have long-lasting pain and then develop progressive neurological symptoms secondary to spinal cord compression. The mean duration of symptom progression at diagnosis is 1 year. MRI is the most reliable examination for the diagnosis of spinal angiolipoma. Total resection is the treatment of choice. No adjuvant treatment is indicated. Since SAL are very haemorrhagic lesions, preoperative embolization is recommended. Conclusion We think that spinal cord compression caused by angiolipoma have very good functional prognosis, even if tardily diagnosed
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23
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Lacour M, Gilard V, Marguet F, Curey S, Perez A, Derrey S. Sudden paraplegia due to spontaneous bleeding in a thoracic epidural angiolipoma and literature review. Neurochirurgie 2018; 64:73-75. [PMID: 29472020 DOI: 10.1016/j.neuchi.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/06/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spinal angiolipomas are rare epidural tumours that are usually revealed by chronic symptoms of medullar irritation. We report a case of acute paraplegia caused by spontaneous bleeding revealing a thoracic angiolipoma. CASE DESCRIPTION A 17-year-old male patient with no previous medical history was admitted for acute onset of paraplegia with bladder retention and loss of sensation in the lower limbs, preceded by dorsal pain during the three previous days. MRI showed an enhanced T1-weighted image of a T7-T12 epidural lesion. The T1-weighted isosignal and the T2-weighted hyposignal suggested haemorrhagic complications. Due to a mass effect on the spinal cord, an emergency laminectomy was performed. Histopathological examination of the lesion revealed an angiolipoma with spontaneous bleeding. Clinical outcome was favourable after two months. CONCLUSION This case is one of the first to be reported, although the clinical presentation is similar to that of other rare reported cases of paraplegia due to spinal compression by tumoural bleeding.
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Affiliation(s)
- M Lacour
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | - V Gilard
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - F Marguet
- Department of Pathology, Normandie Univ, UNIROUEN, Inserm UMR 1073, Rouen University Hospital, 76031 Rouen, France
| | - S Curey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - A Perez
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France; Department of Neurosurgery, Normandie Univ, UNIROUEN, Inserm UMR 1073 Rouen University Hospital, 76031 Rouen, France.
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24
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Yang T, Wang F, Niu C. Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas. Oncol Lett 2018; 15:6036-6042. [PMID: 29552231 DOI: 10.3892/ol.2018.8024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/11/2018] [Indexed: 12/31/2022] Open
Abstract
The majority of spinal cavernous angiomas (CAs) originate from the vertebral bodies with or without epidural space extension. Solitary epidural CAs are rare. In the present study, we retrospectively reviewed the records of 12 patients who underwent microsurgery for solitary spinal epidural CAs. All patients had performed pre- and postoperative magnetic resonance imaging. The patients were 7 females and 5 males with the mean age of 52.1 years. Two tumors were located in the cervicothoracic spine, nine in the thoracic spine and one in the lumbar spine, respectively. Solitary epidural CAs generally exhibited isointensity on T1-weighted images and hyperintesity on T2-weighted images. Contrast-enhanced T1-weighted images showed homogeneous markedly enhancement. Gross total resection (GTR) was achieved in 11 cases, and subtotal resection (STR) was achieved in 1 case. During an average follow up of 35.9 months, neurological function was improved in 11 patients and in one patient, preoperative status was maintained. No patient experienced tumor recurrence. These findings suggest that CAs should be considered in the differential diagnosis of spinal epidural lesions. Early surgery is advocated to prevent irreversible neurological deficits. When aggravated by a large amount of acute hemorrhage, neurological deterioration is usually acute and prompt surgical decompression is the optimal choice. Because of the excessive vascularity of CAs, en bloc resection is recommended. In addition, a good clinical outcome after GTR can be expected, and the risk of long-term recurrence is low.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
| | - Fei Wang
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
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25
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Kang HI, Kim TW, Kim EJ, Park KH. Angiolipoma on the Lumbar Spine. KOREAN JOURNAL OF SPINE 2017; 14:112-114. [PMID: 29017310 PMCID: PMC5642094 DOI: 10.14245/kjs.2017.14.3.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
Angiolipomas are composed of mature adipose tissue and blood vessels. Spinal angiolipomas are rare benign tumors with a good prognosis, and most symptoms are due to progressive compression of the spinal cord and root. The treatment of choice is total resection without any additional therapy. We report a case of an epidural angiolipoma on the lumbar spine in a 69-year-old man with weakness of the lower extremities. Lumbar magnetic resonance images revealed a well-enhanced epidural mass. He underwent laminectomy, and the tumor was completely removed. Pathologic examination confirmed the tumor was an angiolipoma. The patient's symptoms gradually improved postoperatively.
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Affiliation(s)
- Hee Il Kang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Eun Ju Kim
- Department of Pathology, VHS Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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26
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Akyuva Y, Gonultas A, Karaaslan N, Gulciftci Dagci Z, Saglik S, Isyar M, Mahirogullari M. Lumbar Spinal Angiolipoma with Expanding Left Neural Foramen Mimicking Lumbar Schwannoma; Case Report and Review of The Literature. Open Neurol J 2017; 11:20-26. [PMID: 29151988 PMCID: PMC5678235 DOI: 10.2174/1874205x01711010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/09/2017] [Accepted: 08/09/2017] [Indexed: 01/30/2023] Open
Abstract
Aim To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature. Methods Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: "OR", "AND". On-line literature searches were conducted using the key words "lumbar angiolipoma", "schwannoma ", "spinal angiolipoma", "spinal cord", and "spinal canal". We compared this research with our patient. Results Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma. Conclusion The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression.
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Affiliation(s)
- Yener Akyuva
- Republic of Turkey, Ministry of Health, State Hospital, Department of Neurosurgery, 59100, Tekirdag, Turkey
| | - Aylin Gonultas
- Republic of Turkey, Ministry of Health, State Hospital, Department of Pathology, 59100, Tekirdag, Turkey
| | - Numan Karaaslan
- Namik Kemal University School of Medicine, Department of Neurosurgery, 59030, Tekirdag, Turkey
| | - Zehra Gulciftci Dagci
- Republic of Turkey, Ministry of Health, State Hospital, Department of Pathology, 59100, Tekirdag, Turkey
| | - Semih Saglik
- Republic of Turkey, Ministry of Health, State Hospital, Department of Radiology, 56100, Siirt, Turkey
| | - Mehmet Isyar
- Medicalpark Bahcelievler, Department of Orthopaedic and Traumatology, 34050, Istanbul, Turkey
| | - Mahir Mahirogullari
- Istanbul Memorial Health Group, Department of Orthopaedic and Traumatology, 34758, Istanbul, Turkey
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27
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Cultrera F, Cozzi F, Lofrese G, Riccioni L, Cataldi ML, Tosatto L. Spinal angiolipoma. J Neurosurg Sci 2017; 63:98-99. [PMID: 28884558 DOI: 10.23736/s0390-5616.17.04024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Francesco Cozzi
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
| | - Luca Riccioni
- Department of Pathology, Ospedale M. Bufalini, Cesena, Italy
| | - Maria L Cataldi
- Department of Neuroradiology, Ospedale M. Bufalini, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
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28
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Onishi FJ, Salem FAS, de Melo Lins DL, Dauar RFB, Stavale JN. Spinal thoracic extradural angiolipoma manifesting as acute onset of paraparesis: Case report and review of literature. Surg Neurol Int 2017; 8:150. [PMID: 28791193 PMCID: PMC5525459 DOI: 10.4103/sni.sni_467_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/22/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Angiolipomas are benign tumors most commonly found in the thoracic spine. They are composed of mature adipocytes and abnormal vascular elements that usually present with a slowly progressive course of neurological deterioration. CASE DESCRIPTION A 35-year-old female, with a prior history of back pain, acutely developed paraparesis. When the thoracic magnetic resonance imaging (MRI) revealed a dorsal epidural mass at the T3-T5 level, she underwent a laminectomy for gross total excision of the lesion that proved to be an angiolipoma. On the second postoperative day, the patient was again able to ambulate. CONCLUSION The angiolipomas of spine are rare causes of spinal cord compression, and those presenting with acute neurological deficits should be immediately treated.
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29
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Wu Z, Wan H, Shi M, Li M, Wang Z, Yang C, Gao W, Li Q. Bronchoscopic resection of bronchial angiolipoma: A rare case report. Mol Clin Oncol 2017; 5:850-852. [PMID: 28101361 DOI: 10.3892/mco.2016.1069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 10/20/2016] [Indexed: 11/06/2022] Open
Abstract
Angiolipoma is a rare benign tumor that most commonly occurs in the extremities and trunk. Angiolipomas originating in the bronchial tree are extremely rare. To the best of our knowledge, only one such case, confined to the bronchus intermedius, has been reported to date. The present study describes the case of an asymptomatic 74-year-old man with a yellowish round mass incidentally discovered at the orifice of the right lower bronchus during a routine health check. The tumor originated from the membranous part of the right inferior bronchus. Using a high-frequency electric snare and argon plasma coagulation under general anesthesia, successful bronchoscopic resection of the tumor was performed. At 15 months after the surgery, the patient remained recurrence- and symptom-free.
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Affiliation(s)
- Zhiqiang Wu
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Hongli Wan
- Department of Gynecology and Obstetrics, Sichuan Provincial Communications Department Highway Bureau Hospital, Chengdu, Sichuan 611731, P.R. China
| | - Min Shi
- Department of Pathology, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Ming Li
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Zhanpeng Wang
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Caixia Yang
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Wei Gao
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
| | - Qingxin Li
- Department of Thoracic Surgery, Lanzhou General Hospital of PLA, Lanzhou, Gansu 730050, P.R. China
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Carrasco Moro R, Gutiérrez Cierco JA, Martínez San Millán JS, Pian H, Martínez Rodrigo MA. Spinal extradural angiolipomas: 7 new cases and review of the literature. Neurologia 2017; 34:98-104. [PMID: 28081976 DOI: 10.1016/j.nrl.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We present our experience with the diagnosis and treatment of spinal angiolipomas (SAL). METHODS We used our database of surgical patients to gather epidemiological, clinical, diagnostic, treatment, and follow-up data from confirmed cases of SAL. Patients' functional status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score for thoracic myelopathy. RESULTS We included 7 patients with ages ranging between 42 and 63 years; 4 were women. Lesions in all patients were located in the thoracic epidural space; in 2 cases, lesions extended outside the spinal canal. The most frequent form of presentation was pain combined with progressive myelopathy; patients scored 5 to 9 points on the mJOA scale. Radiological findings varied; this variability clearly depended on the proportion of tumour components (cellular variant in one case, predominantly angiomatous in another, and myxoid in yet another case). Four cases displayed radiological signs of bone involvement. Surgery resulted in excellent mJOA scores except in one case (mJOA score of 10); no recurrences were detected during follow-up (periods ranging from 1 to 5 years). CONCLUSIONS Extradural SAL can present with highly variable radiological and clinical features. Surgery must be tailored to each individual situation according to tumour extension; in some cases, it may include spinal reconstruction. Surgery results in excellent outcomes regardless of preoperative functional status and it is associated with low recurrence rates, even in case of incomplete resection.
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Affiliation(s)
- R Carrasco Moro
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | | | - H Pian
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
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Shweikeh F, Sangtani A, Steinmetz MP, Zahos P, Chopko B. Spinal angiolipomas: A puzzling case and review of a rare entity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:91-96. [PMID: 28694590 PMCID: PMC5490357 DOI: 10.4103/jcvjs.jcvjs_23_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with spinal epidural abscesses (SEAs) may have a variable presentation. Such an infection has a typical appearance on magnetic resonance imaging (MRI) and enhances with gadolinium. We present a case that was a diagnostic challenge where pre- and intra-operative findings resulted in conflicting impressions. The mimicker was a spinal angiolipoma (SAL). The authors then provide a thorough review of this rare spinal neoplasm. A 55-year-old man presented with back pain, paresis, paresthesia, and urinary retention. MRI was indicative of a longitudinal epidural thoracic mass with a signal homogeneous to nearby fat, curvilinear vessels, and lack of enhancement. Although at emergent surgery, the lesion was found to contain abundant purulent material. Microbiology was positive for methicillin-resistant Staphylococcus aureus and consistent with SEA without evidence of neoplasia. While the imaging features were suggestive of an angiolipoma, the findings at surgery made SEA more likely, which were validated histopathologically. The diagnosis of SEA is often clear-cut, and the literature has reported only a few instances in which it masqueraded as another process such as lymphoma or myelitis. The case highlights SEA masquerading as an angiolipoma, and further demonstrates to clinicians that obtaining tissue diagnosis plays a crucial role diagnostically and therapeutically. SALs, on the other hand, are slow-growing tumors that can be infiltrating or noninfiltrating. They typically present with chronic symptoms and T1-MRI shows an inhomogeneous picture. Complete surgical excision is standard of care and patients tend to do well afterward.
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Affiliation(s)
- Faris Shweikeh
- Summa Health System, Northeast Ohio Medical University, Rootstown, USA.,College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Ajleeta Sangtani
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Michael P Steinmetz
- Department of Neurosurgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Peter Zahos
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Bohdan Chopko
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA.,Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
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Glynn D, Murray B, Cryan J, O'Brien D, Kavanagh E. Spinal epidural angiolipoma. Spine J 2016; 16:e531-2. [PMID: 26944587 DOI: 10.1016/j.spinee.2016.01.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/26/2016] [Indexed: 02/03/2023]
Affiliation(s)
- David Glynn
- Department of Breast Surgery, Mater Misercordiae University Hospital, Eccles street, Dublin 7, Ireland
| | | | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin 9, Ireland
| | - Donncha O'Brien
- Department of Radiology, Mater Misercordiae University Hospital, Dublin 7, Ireland
| | - Eoin Kavanagh
- Department of Breast Surgery, Mater Misercordiae University Hospital, Eccles street, Dublin 7, Ireland
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Isla A, Ortega Martinez R, Pérez López C, Gómez de la Riva A, Mansilla B. [Lumbar spinal angiolipoma]. Neurocirugia (Astur) 2016; 27:258-62. [PMID: 27263067 DOI: 10.1016/j.neucir.2016.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/26/2016] [Accepted: 02/27/2016] [Indexed: 11/30/2022]
Abstract
Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection.
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Affiliation(s)
- Alberto Isla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España.
| | | | | | | | - Beatriz Mansilla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
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Mohammed ZI, Ahmed MMZ. Spinal extradural angiolipoma manifested after normal vaginal delivery. BMC Res Notes 2016; 9:132. [PMID: 26928853 PMCID: PMC4772527 DOI: 10.1186/s13104-016-1944-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/17/2016] [Indexed: 11/28/2022] Open
Abstract
Background Extradural spinal angiolipomas are extremely rare benign neoplasms made up of mature lipocytes with abnormal blood vessels. Spinal angiolipomas represent only 0.14–1.2 % of all spinal axis tumours. Case presentation A case of thoracic spinal extradural angiolipoma producing acute spinal cord compression in a 35-year old housewife is presented. Patient presented with sudden onset of lower limbs paralysis and urinary incontinence for 1 month after vaginal delivery. Patient was diagnosed as dorsal spine angiolipoma which was treated surgically with excellent outcome. Conclusions Spinal angiolipomas are rare tumours but it is mandatory to include it in the differential diagnosis of the spinal extradural space occupying lesions. Pregnancy and vaginal delivery may suddenly exacerbate the condition. The best investigation to choose to diagnose these lesions is definitely magnetic resonance imaging of the spine. The aim of treatment of extradural angiolipomas of the spine is to resect the tumour in Toto surgically with no need of adjuvant therapy, surgery alone can lead to excellent outcome.
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Affiliation(s)
| | - Moayad M Z Ahmed
- , Aljerief West 1st block plot number 398, P.O. Box 10995, Khartoum, Sudan.
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Bouali S, Maatar N, Bouhoula A, Abderrahmen K, Said IB, Boubaker A, Kallel J, Jemel H. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes. Asian J Neurosurg 2016; 11:348-351. [PMID: 27695535 PMCID: PMC4974956 DOI: 10.4103/1793-5482.180901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. METHODS A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. RESULTS A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. CONCLUSIONS The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.
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Affiliation(s)
- Sofiene Bouali
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Nidhal Maatar
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Asma Bouhoula
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Khansa Abderrahmen
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Imed Ben Said
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Adnen Boubaker
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Jalel Kallel
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Benvenutti-Regato M, De la Garza-Ramos R, Caro-Osorio E. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature. Int J Spine Surg 2015; 9:67. [PMID: 26767159 PMCID: PMC4710163 DOI: 10.14444/2067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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.
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Affiliation(s)
- Mario Benvenutti-Regato
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
| | - Rafael De la Garza-Ramos
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
| | - Enrique Caro-Osorio
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
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Eap C, Bannwarth M, Jazeron JF, Kleber JC, Theret É, Duntze J, Litre CF. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma. Neurochirurgie 2015; 61:398-400. [DOI: 10.1016/j.neuchi.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/28/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 2015; 25:134-9. [PMID: 26778809 DOI: 10.1016/j.jocn.2015.08.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/01/2015] [Accepted: 08/14/2015] [Indexed: 12/14/2022]
Abstract
Spinal angiolipomas are uncommon benign tumours composed of mature fatty tissue and abnormal vascular elements, most commonly found within the posterior spinal epidural space. Most tumours are located within the mid-thoracic spine; in contrast thoracolumbar junction and purely lumbar angiolipomas are rare. We report a case series of four spinal angiolipomas, including a thoracolumbar junction and a purely lumbar tumour.
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Affiliation(s)
- Kenneth Sim
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
| | - Alpha Tsui
- Department of Pathology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Iddo Paldor
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Frank Gaillard
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
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Spinal cavernous extradural angiolipoma manifesting as a spontaneous spinal epidural hematoma in a child. Childs Nerv Syst 2015; 31:1223-6. [PMID: 26065860 DOI: 10.1007/s00381-015-2760-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Angiolipomas are benign tumors usually manifested as subcutaneous nodules. Rarely they may form spinal extradural masses. These spinal cavernous angiolipomas have mostly been described in adults. DIAGNOSIS To our knowledge, spinal cavernous angiolipomas have been reported in nine pediatric patients. CLINICAL PRESENTATION In this paper, we present a 1-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal cavernous angiolipoma and highlight the importance of conducting a histopathological analysis of spontaneous hematomas in previously healthy children.
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Abstract
Angiolipomas of the spine are rare benign tumors commonly presenting with compressive myelopathy. The present report describes a case of spinal angiolipoma with thoracic mediastinal extension in a 50-year-old woman. She presented with a long-standing history of mid-back pain with progressive lower extremities weakness. An MRI showed a heterogeneously enhancing mass located in the posterior epidural space of the thoracic spine with mediastinal extension. Histopathological examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the diagnosis and therapeutic management options of infiltrating spinal angiolipomas.
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Affiliation(s)
- Mustafa M Nadi
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail:
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Nakao Y, Shimokawa N, Tsukazaki Y, Terada A, Nakajo K, Fu Y. Radical excision combined with instrumented fixation in the management of thoracic epidural angiolipoma: a case report. J Med Case Rep 2014; 8:377. [PMID: 25412677 PMCID: PMC4275755 DOI: 10.1186/1752-1947-8-377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 10/19/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Spinal angiolipoma is a benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04% to 1.2% of all spinal tumors. We present a case of thoracic epidural angiolipoma treated by combining radical resection with instrumented spinal fixation, without any surgical complication. Case presentation A 32-year-old Asian woman presented with dorsal epidural angiolipoma at the upper-thoracic level. She had a seven-month history of gradually worsening weakness and numbness in her lower extremities. Imaging studies of her thoracic spine demonstrated a heterogeneously well-enhancing mass, located in her posterior epidural space without surrounding bone erosion at the upper thoracic level. We also observed compression of her thoracic cord. During surgery, a reddish-gray, highly vascularized mass was excised. Her facet joints had to be resected to expose the part migrating into the intervertebral foramen. Because there was concern regarding the stability of her thoracic spine, we performed spinal fixation using pedicle screws. Histopathological study of the surgical specimen showed a typical angiolipoma. Conclusion Angiolipomas can be radically excised with good prognosis. Surgical removal is the preferred treatment for spinal angiolipoma, and the prognosis after surgical management is very good. Although outcomes remained favorable despite incomplete resections in a number of spinal angiolipoma, complete removal is preferred. We successfully achieved total resection without any surgical complication by combining radical resection with instrumented spinal fixation.
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Affiliation(s)
- Yaoki Nakao
- Department of Neurosurgery, Tsukazaki Hospital, 68-1, Waku, Aboshiku, Himeji 6711106, Japan.
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da Costa MDS, Paz DDA, Rodrigues TP, Gandolfi ACDC, Lamis FC, Stavale JN, Suriano IC, Cetl LDMN, Cavalheiro S. Hemorrhagic onset of spinal angiolipoma. J Neurosurg Spine 2014; 21:913-5. [PMID: 25303620 DOI: 10.3171/2014.9.spine131162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal angiolipomas are rare benign tumors that generally induce slow progressive cord compression. Here, the authors describe a case of sudden-onset palsy of the lower extremities caused by hemorrhagic spinal angiolipoma. An emergent laminectomy was performed to achieve total lesion removal. Follow-up examinations indicated neurological improvement and the absence of recurrence.
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Ramdasi RV, Avinasha KM, Mahore A, Kawale J. Spinal angiolipoma manifesting with apoplexy. BMJ Case Rep 2014; 2014:bcr-2014-204379. [PMID: 24842366 DOI: 10.1136/bcr-2014-204379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a 58-year-old man presenting with acute paraplegia. MRI showed a haematoma within a well-defined epidural lesion at C7-D1. Intraoperatively, organised epidural haematoma surrounded by tumour tissue was found. The final histopathology report was angiolipoma. The patient had dramatic recovery. Angiolipomas should be considered in the differential diagnosis of acute paraplegia when imaging shows well-circumscribed haematoma.
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Affiliation(s)
| | - K M Avinasha
- Department of Neurosurgery, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Amit Mahore
- Department of Neurosurgery, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Juhi Kawale
- Department of Medicine, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Bovier EG, Gardino E, Chemes LN, Nogueira F, Romero VD. Acute paraplegia by spinal angiolipoma. Case report and literature review. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130200403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal angiolipoma is an uncommon form of benign tumor. There are 142 reported cases and only one of acute paraplegia. We describe a case of a 39 year old male with acute spinal paraplegia angiolipoma in T4-T5 with surgical resolution three weeks after the onset of the neurological syndrome. Postoperative neurologic recovery was complete. The angiolipoma consists of mature fat cells and abnormal blood vessels. There are 2 types: non-infiltrating and infiltrating. Its clinical course is slow and progressive, it can be accelerated by vascular phenomena, intratumoral abscess, and pregnancy. There is just one report of spontaneous intratumoral hemorrhage and acute paraplegia, coinciding with our case. There is no consensus as to treatment, and release and complete resection are suggested, as it is a disease with good prognosis. Angiolipoma spinal epidural is a rare form of benign tumor, and the treatment of this pathology continues to be release and resection of the tumor, with a favorable prognosis, despite the delay in surgery, as in the case reported. Intratumoral bleeding should be considered a cause of acute spinal compression syndrome, as ocurred in our patient.
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Si Y, Wang Z, Pan Y, Lin G, Yu T. Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:417-25. [PMID: 24190280 DOI: 10.1007/s00586-013-3073-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 10/12/2013] [Accepted: 10/13/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE To summarise our experience treating patients with spinal angiolipomas (SAs) and to evaluate factors relating to its prognosis. METHODS We retrospectively reviewed the records of patients diagnosed with SAs who received surgical treatment from January 2001 to February 2013. RESULTS Twenty-one patients were described. We divide SAs into two types: "intraspinal" and "dumbbell-shaped". The former were further subclassified as "with lipomatosis" and "without lipomatosis". Overweight people are more likely to get the "with lipomatosis" type which needs different surgical strategy and/or a diet therapy to get better outcomes. CONCLUSION Diagnosis of SAs should be made with reference to clinical, radiological, and pathological findings. Application of different methods is needed to treat SAs.
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Affiliation(s)
- Yu Si
- Department of Neurosurgery, Peking University Third Hospital, No. 49. North Garden Street, HaiDian District, Beijing, 100191, People's Republic of China,
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Thoracolumbar spinal angiolipoma demonstrating high signal on STIR imaging: a case report and review of the literature. Spine J 2013; 13:e1-5. [PMID: 24071036 DOI: 10.1016/j.spinee.2013.06.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 02/05/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Angiolipomas are rare benign tumors, accounting for 0.14% to 1.2% of all tumors of the spinal axis with vascular and fatty histological features. Spinal angiolipoma (SAL) is most commonly found in the thoracic region and has high signal on contrast enhanced fat-saturated T1-weighted imaging. Although the international literature is extensive, there are few cases reported in United States. OBJECTIVE To present a case of SAL located in the thoracolumbar region without high signal on contrast enhanced fat-saturated T1-weighted imaging and to review previously reported cases. STUDY DESIGN/METHODS Case report and review the literature. RESULTS Magnetic resonance imaging obtained in a 68-year-old man with a long history of lumbago showed a heterogeneous mass (T10-L1) hyperintense on T1-weighted imaging but not enhancing on suppression fat sequences, suggesting epidural hematoma. Surgical excision of the lesion was performed, and SAL was diagnosed and confirmed by pathology. The patient became asymptomatic. CONCLUSIONS The predominance of either vascular or fatty components inside the tumor might alter the expected results on magnetic resonance imaging with suppression fat sequences.
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Hu S, Hu CH, Hu XY, Wang XM, Dai H, Fang XM, Cui L. MRI features of spinal epidural angiolipomas. Korean J Radiol 2013; 14:810-7. [PMID: 24043978 PMCID: PMC3772264 DOI: 10.3348/kjr.2013.14.5.810] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Materials and Methods Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Results Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Conclusion Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
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Chotai S, Hur JS, Moon HJ, Kwon TH, Park YK, Kim JH. Spinal angiolipoma--case report. Neurol Med Chir (Tokyo) 2013; 51:539-42. [PMID: 21785253 DOI: 10.2176/nmc.51.539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 69-year-old male presented with a rare spinal angiolipoma manifesting as history of back pain, and numbness in both lower limbs, which progressed over a period of 5 years. Total T10-T12 laminectomy was performed and the tumor was removed en bloc. The symptoms gradually improved postoperatively. Spinal angiolipoma is an uncommon benign extradural tumor of spine, which accounts for 0.14-1.2% of all spinal tumors and is a rare cause of spinal cord compression. Recognition of this entity is crucial as a benign and curable cause of paraplegia and back pain.
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Affiliation(s)
- Silky Chotai
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, ROK
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Meng J, Du Y, Yang HF, Hu FB, Huang YY, Li B, Zee CS. Thoracic epidural angiolipoma: A case report and review of the literature. World J Radiol 2013; 5:187-192. [PMID: 23671756 PMCID: PMC3647212 DOI: 10.4329/wjr.v5.i4.187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/18/2012] [Accepted: 01/21/2013] [Indexed: 02/06/2023] Open
Abstract
Angiolipoma of the spine is a benign neoplasm consisting of both mature fatty tissue and abnormal vascular elements, and usually presents with a slow progressive clinical course. Our patient presented with bilateral lower extremity weakness and chest-back numbness. Physical examination revealed adipose elements superficial hypesthesia below the T5 level and analgesia below the T6 level. Magnetic resonance imaging (MRI) scan showed an avidly and heterogeneously enhancing mass which was located in the posterior epidural space. Compression of the thoracic cord by the fusiform mass was seen between T3-T4. During the operation, a flesh pink vascular mass (4.7 cm × 1.0 cm × 1.0 cm) with obscure margin and strong but pliable texture was found in the posterior epidural space extending from T3 to T4. There was no infiltration of the dura or the adjacent bony spine. Histopathological study of the surgical specimen showed a typical angiolipoma. We review the previously documented cases of spinal extradural angiolipomas performed with MRI.
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Rodrigues JCL, Mortimer AM, Love S, Renowden SA. A rare cause of neural foraminal widening. J Radiol Case Rep 2013; 6:1-8. [PMID: 23365697 DOI: 10.3941/jrcr.v6i12.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The differential diagnosis for lesions causing neural foraminal widening is vast. The majority are solitary benign peripheral nerve sheath tumours, such as neurofibromas or schwannomas. We present a case of a rare cause of neural foraminal expansion secondary to a posterior thoracic extradural angiolipoma. We describe the presence of chemical shift artefact on post gadolinium T1-weighted imaging as indirect evidence of a fatty component. This potentially important diagnostic sign may raise the suspicion of angiolipoma, especially in an isointense or hypointense dumbbell lesion on T1-weighted imaging, and has not been described previously in this context. Accurate radiological diagnosis of an angiolipoma is important to reduce unexpected haemorrhagic complications from biopsy or resection of the lesion.
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