Extradural spinal angiolipoma

Demographic and clinical data of patients with spinal epidural angiolipomas

Spinal epidural angiolipomas are rare, benign, mesenchymal tumors. It remains unclear whether spinal epidural angiolipomas are genuinely rare or merely underreported. Herein, we assessed the demographic and clinical characteristics of patients with spinal epidural angiolipoma. We collected data from patients with spinal epidural angiolipoma from three sources. First, we retrospectively analyzed data from patients diagnosed with spinal epidural angiolipoma in our hospital between January 1, 2014, and December 31, 2023. Second, we performed a literature review of studies retrieved from PubMed. Third, we retrieved detailed data of patients with spinal angiolipoma from the Surveillance, Epidemiology, and End Results (SEER) database. We conducted a descriptive analysis to investigate the demographic and clinical characteristics of patients with spinal epidural angiolipoma. At our institution, three patients were diagnosed with spinal epidural angiolipoma. Additionally, we identified 116 patients from the literature review and 15 patients from the SEER database. We reviewed the treatment history and imaging features of the three patients from our institution. The descriptive analysis of the data collected from the literature review was consistent with previous reports. For example, 63.0% of lesions were located at the thoracic level. 31.9% of these lesions involved two vertebral bodies, while 75.6% involved 2-4 vertebral bodies. The most common symptoms experienced by patients were back pain, paraparesis, and numbness in the legs. Surgery was the primary treatment option for most patients, and complete tumor resection was achieved in the majority of patients. The male:female ratio was 1:1.4, the median age at diagnosis for the patients from the literature was 49 years old, and the median follow-up was 24 months. Notably, most of the reports came from Asia and there were few reports from Africa. The findings from the SEER database indicated a male:female ratio of 2:1. The peak incidence, which is typically reported in the fifth decade of life, was not observed. We presented three cases of spinal epidural angiolipoma and supplemented our findings with a literature review and population-based analysis according to the SEER database for the United States population. We believe that our research will enhance clinicians' comprehension of this uncommon tumor.

Clinical features and surgical outcomes of spinal epidural angiolipomas

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.

Microsurgical treatment for spinal epidural angiolipomas

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.

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

Spinal angiolipomas (SALs) are extremely rare benign tumors composed of both mature fatty tissue and anomalous vascular channels. We present two cases of SALs and review the clinical presentation, radiological appearance, pathological aspects, and treatment of this distinct clinicopathological mass. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence or neurological deficit. SAL should be considered as a differential diagnosis in patients with spinal cord compression. Magnetic resonance imaging is important for detecting and characterizing SALs. The gold standard treatment modality should be total resection.

Sudden Aggravated Radicular Pain Caused by Hemorrhagic Spinal Angiolipomas After Back Massage

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.

Spinal extradural angiolipomas: 7 new cases and review of the literature

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.

Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

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.

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

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.

Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature

A 40-year-old male presented with mid-thoracic backache and progressive, ascending, spastic, paraparesis for one year. Magnetic resonance imaging demonstrated an extraosseous, extradural mass, without any bone invasion at the T2-T4 vertebral levels, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was totally excised after a T2-T4 laminectomy. Histopathological examination revealed a cavernous hemangioma. The authors reported this case and reviewed the literature, to explain why extraosseous, extradural, cavernous hemangiomas should be considered in the differential diagnosis of extradural thoracic compressive myelopathy.

Thoracolumbar spinal angiolipoma demonstrating high signal on STIR imaging: a case report and review of the literature

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.

MRI features of spinal epidural angiolipomas

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.

[Spinal epidural angiolipoma: a case report]

Spinal epidural angiolipoma is a rare tumor revealed by a slowly progressive paraplegia. We reported a case of a 44-year-old female and point out the peculiar pattern of this lesion characterized by the prominence of the vascular component over the lipomatous component. Recognition of this entity is important because this is a benign and curable cause of paraplegia.

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

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

Lumbar spinal extradural angiolipoma: case report and review of the literature

Angiolipomas in the lumbar spinal region are extremely rare. The present report describes the identification of such a tumor and its removal, and discusses the tumor characteristics and prognosis. A 74-year-old woman was presented with a 5-month history of lower back pain. Severe radiculopathy was experienced in the left leg for 5 days prior to the presentation, and there were no neurological deficits. Magnetic resonance (MR) images showed an approximately 3.5 cm heterogeneously enhanced and elongated mass at the left L5-S1 level. A portion of the mass appeared with high signal intensity on T2-weighted MR images, with low signal intensity on T1-weighted images, and with high signal intensity on T1 fat suppression enhancement images. Resection of the tumor was approached via an L5 and S1 laminectomy. A fibrous sticky yellowish hypervascular tumor was identified. Histological study revealed the tumor as an angiolipoma. Symptoms were relieved after tumor excision, and there were no neurological sequelae. Although extremely rare, lumbar epidural angiolipoma should be considered in the differential diagnosis of lumbar spinal epidural lesions. The prognosis after surgical management of this lesion is favorable.

Infiltrating spinal angiolipoma

Infiltrating angiolipomas are rarely encountered in the spine. We present a case involving a 71-year-old man with a dorsal epidural angiolipoma at the T5-T7 level. The tumor involved the T5-T6 vertebral bodies and left pedicle. The patient presented with acute paraparesis and MRI showed a homogeneously hyphointense lesion on T1-weighted images. The epidural component of the tumor was removed via laminectomy to achieve adequate cord decompression. The patient was symptom-free at a 2-year follow-up. This report emphasizes the unusual clinical presentation and MRI features of an infiltrating spinal angiolipoma and discusses therapeutic management options.

Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature

Background

Soft tissue tumors of the feet are uncommon and there have been very few reports of large series in the literature. These tumors continue to present the clinician with one of the most difficult problems in medicine.

Case presentation

We present a case of a large multilobular noninfiltrating angiolipoma at the plantar surface of the forefoot. Only three cases occurring at the foot have been previously described. We report this new case due to unusual location of the tumor, the long duration (25 years) of its existence and the unique surgical approach for the tumor excision.

Conclusion

Surgical excision is the treatment of choice and adjuvant radiotherapy is indicated in select cases.

Spinal angiolipoma: case report and literature review

BACKGROUND/OBJECTIVE

Spinal angiolipoma (SAL) is an uncommon clinico-pathological entity.

DESIGN

Single case report.

METHODS

Retrospective data analysis.

FINDINGS

An obese woman with a 1-year history of progressive spastic paraparesis and acute deterioration underwent magnetic resonance imaging of the thoracic spine, the results of which suggested a tumor compressing the thoracic spinal cord. The histopathological examination of the completely resected tumor revealed an epidural angiolipoma.

CONCLUSIONS

This case report offers a reminder that SAL should be considered in the differential diagnosis of long-standing, slowly progressive paraparesis. It remains unclear whether an increased body mass index might be a contributing factor to the development of SAL.

Lumbar extradural infiltrating angiolipoma: a case report and review of 17 previously reported cases with infiltrating spinal angiolipomas

BACKGROUND CONTEXT

Spinal extradural angiolipomas are rare benign tumors, and most of them are noninfiltrating tumors located in the extradural space. However, there are 17 cases with extradural infiltrating spinal angiolipomas extending into the vertebral bodies or posterior vertebral arches in literature. These 17 tumors are mostly located at the thoracic region, and anterior or in the anterolateral extradural space, and they generally infiltrate only one vertebra. Only two of them are located at the lumbar region, four are mainly located in the posterior extradural space, and three infiltrate more than one vertebra.

PURPOSE

To present an exceptional case with infiltrating extradural spinal angiolipoma involving two lumbar segments and mainly located in the posterior extradural space.

STUDY DESIGN

A case report.

METHODS

A 41-year-old woman with infiltrating spinal angiolipoma was treated by incomplete surgical removal of the tumor.

RESULTS

There were no complaints nor recurrence after 18 months follow-up.

CONCLUSIONS

Outcome after surgery for spinal angiolipomas is very good overall even in the cases with infiltrating tumors. Although complete removal is certainly preferred, outcomes remained favorable despite incomplete resections.

Epidural angiolipoma is histologically distinct from its cutaneous counterpart in the calibre and density of its vascular component; a case report with review of the literature

Angiolipoma of the spine is a rare tumour and no studies have investigated a sufficient number of cases to reach general conclusions. Therefore, as yet, the pathological definition of this entity is not well established. The case of epidural angiolipoma reported here and a review of the literature revealed that this entity is distinct from cutaneous angiolipoma in that the calibre of its predominant vascular component is far greater than that of the fat cells. Therefore, epidural angiolipoma can be regarded as not only topographically, but also histologically, distinct from its subcutaneous counterpart.

Intracranial angiolipoma as cause of subarachnoid haemorrhage. Case report and review of the literature

A 33-year-old female with a longstanding history of seizures was admitted to our hospital with subarachnoid haemorrhage (SAH). Computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) depicted a vascular fat-containing lesion overlying a right frontal cortical polymicrogyria. The diagnosis of angiolipoma was established. Conservatory management was undertaken with full recovery. She has been followed for 5 years since, with neither re-bleeding nor morphologic change of the lesion. This is a rare intracranial lesion, with only 11 intracranial angiolipomas published in the literature, and is the first case reported which is associated with SAH caused by this lesion.

Lumbar spinal angiolipomas: report of two cases and review of the literature

STUDY DESIGN

Case report and review of the literature.

OBJECTIVES

To describe two patients with angiolipoma in the ventral aspect of the lumbar epidural space, to discuss the clinical, radiologic, and surgical features of these lesions, and to review previously reported cases.

SETTING

Rome, Italy.

METHODS

Two cases, a 60-year-old man and a 54-year-old woman presented with lumbar-sciatic pain but with no abnormal neurological signs. Investigation (CT and MRI) demonstrated lumbar tumours.

RESULTS

Laminectomy and excision of the tumors were performed, and symptoms improved immediately.

CONCLUSIONS

Magnetic resonance imaging with suppression fat sequences allows the recognition of these lesions. The prognosis after surgical removal of spinal angiolipoma is favorable.

Lumbosacral angiolipoma: case report

We present a case of a 46-year old woman with a ventral epidural angiolipoma at the lumbosacral level with erosion of the sacrum. About ninety cases of spinal angiolipomas have been previously described in the literature, most of them situated on the thoracic region, dorsal to the dural sac. Angiolipomas can be radically excised with a good prognosis even in the presence of bone erosion. We did not find any other angiolipoma at the sacral level surgically explored in the review of the literature.

Spinal angiolipoma

BACKGROUND

Spinal epidural angiolipoma is a rare cause of spinal cord compression. We present a case and review the clinical presentation, radiological appearance, pathological aspects and treatment of this distinct clinico-pathological entity.

METHODS

A case of a 46-year-old woman with a five-month history of progressive myelopathy affecting her lower extremities is presented. CT and MRI revealed a large epidural fat-containing mass compressing the spinal cord dorsally at the T7-T8 level. A laminectomy was performed with gross total resection of the lesion.

RESULTS

The patient's neurologic symptoms improved postoperatively. A two-year follow-up period has revealed no signs of tumor recurrence and no neurological deficit.

CONCLUSION

The diagnosis of spinal angiolipoma should be considered in the differential diagnosis of spinal cord compression. Magnetic resonance imaging is the investigation of choice. The surgical objective is complete excision but, for anterior lesions involving bone, an overly aggressive approach should be tempered by an awareness of the overall indolent natural history of so-called "infiltrating" spinal angiolipomas that are only partially excised.

Intraspinal osteolipoma. Case report

Lipomatous tumors can contain uncommon or rare components (such as fibrolipoma or angiolipoma) that may result in the development of symptoms. To the best of the authors' knowledge, lipoma associated with an osseous component has not been previously reported. A case of intraspinal extradural tumor composed of both adipose and bone tissue is presented. Current theories on the cause of lipoma with an osseous component are discussed. The tumor was histologically confirmed to be an osteolipoma, and the patient recovered well after resection.

Angiolipomas of the central nervous system

Angiolipomas are neoplasms composed of mature adipocytes admixed with abnormal vascular elements. They are most commonly found in the subcutaneous tissue of the trunk and extremities, but other sites have been reported. The craniospinal axis is an uncommon but significant site. An extensive review of the literature is conducted. We summarize 94 cases of angiolipomas in the central nervous system (CNS) in 92 patients, including five in our own series, to highlight the most prominent features of these tumors. The increasing number of cases of CNS angiolipoma in the era of magnetic resonance imaging raises the question of the rarity of these lesions.

Subacute paraparesis induced by venous thrombosis of a spinal angiolipoma: a case report

STUDY DESIGN

A case report of spinal extradural angiolipoma, a rare tumor that can cause spinal cord compression, is presented with a complete review of the literature related to this disorder.

OBJECTIVES

To discuss venous thrombosis involving the angiolipoma in the development of subacute paraparesis.

SUMMARY OF BACKGROUND DATA

This case shows that venous thrombosis of a spinal angiolipoma can precipitate the subacute onset of paraparesis.

METHODS

Medical history, physical findings, and the results of imaging and histopathologic studies were analyzed to elucidate the pathogenesis of the patient's subacute onset of paraparesis. A bilateral T3-T7 laminectomy was performed, and although the tumor was extremely hemorrhagic, it was mobilized easily off the compressed dura to achieve resection.

RESULTS

The postoperative course was uneventful. One month after her surgery, the patient's myelopathic symptoms had resolved, and the she was able to return to work.

CONCLUSION

Because the prognosis after surgical management of these lesions is favorable, the diagnosis of thrombosis involving a spinal angiolipoma should be considered in the differential diagnosis of subacute spinal cord compression.

Spinal intramedullary angiolipoma

We report the case of a young patient with a thoracolumbar (T11-L3) intramedullary angiolipoma. Total removal of the tumor was possible and after operation the patient's neurological condition greatly improved. Only two previous cases of intramedullary angiolipomas have been reported, and in neither could the lesion be wholly removed. The histopathological and radiological features of these tumors are discussed and the extreme rareness of this case is emphasized.

Sudden infant death syndrome and lipoma: the presence of fat tissue in the spinal canal

An epidural lipoma in the spinal canal in a case of Sudden Infant Death Syndrome (SIDS) is described. Histologic sections from ten SIDS cases were compared with five controls. It is concluded that there are no indications that an increased amount of fat in the spinal canal plays a role in the pathogenesis of SIDS.

Extradural tumor causing spinal cord compression in Klippel-Trenaunay-Weber syndrome

BACKGROUND

Myelopathy in Klippel-Trenaunay-Weber syndrome is uncommon but has been reported secondary to spinal vascular malformations.

REPORT

A patient with Klippel-Trenaunay-Weber syndrome who presented with spinal cord compression from a spinal extradural mass lesion (angiomyolipoma) is described.

DISCUSSION

This association has not been reported previously but is consistent with the segmental vascular abnormalities observed in Klippel-Trenaunay-Weber syndrome.

Hibernoma: MRI appearance of a rare tumor

We report the features of a hibernoma on magnetic resonance (MR) imaging. The MR characteristics of this lesion were consistent with a complex lipid-containing mass. The mass did not suppress on short tau inversion recovery (STIR) imaging and was clearly not a simple lipoma. Hibernoma should be considered in the differential diagnosis of complex fatty masses.

Cavernous angiomas and arteriovenous malformations of the spinal epidural space: report of 11 cases

We have retrospectively studied 11 cases of solitary cavernous and arteriovenous malformations of the spinal epidural space. The acute or subacute onset of symptoms was found in all cases, with a neurological deficit in five cases. A plain x-ray study revealed abnormal calcification in one case. Hyperdensity with no iodine enhancement was found on computed tomographic scans in all cases. Magnetic resonance imaging studies showed ovoid or round lesions with isosignal and gadolinium enhancement on T1-weighted images and hypersignal on T2-weighted images, except in one case with hypersignal on T1 and T2 before the administration of a contrast medium. Four lumbar cases were localized in the posterior vertebral ligament; all the thoracic cases were posterior with foraminal extension. The other cases were anterolateral. The surgical findings revealed a dark vascularized epidural lesion associated in two cases with a localized epidural hematoma. A pathological examination revealed seven cavernous angiomas and four arteriovenous malformations. These arteriovenous malformations were all lumbar, and two of four localized within the posterior ligament. The pathophysiology of these vascular malformations is discussed. In light of the good postoperative prognosis of these lesions, surgical removal is recommended for all the symptomatic cases.

Spinal angiolipomas. Report of three cases

Spinal angiolipomas are distinct, benign lesions composed of mature lipocytes admixed with abnormal blood vessels. Three new cases of spinal angiolipoma are presented and 34 previously reported cases are analyzed. The 37 total cases (23 females and 14 males) ranged in age from 17 to 73 years (mean 43 years; median 45 years). The mean age of the female patients was older than that for the males (45.0 vs. 41.6 years; p < 0.001, Student's t-test) and most were peri- or postmenopausal. Prior to diagnosis, 97% of the patients had weakness of the lower extremities, 94% had sensory dysfunction, 84% had hyperreflexia and spasticity, 51% had sphincter dysfunction, and 41% had back pain lasting from 1 to 180 months (mean 28 months). Five (22%) of the 23 female patients were pregnant and two had exhibited significant weight gain coincident with the onset of symptoms. The angiolipomas were extradural in 35 patients and intramedullary in two; seven of the extradural lesions infiltrated the surrounding bone. The tumors extended from C-6 to L-4 and had a predilection for the midthoracic region (53% of cases). Plain radiographs were abnormal in 11 (39%) of 28 patients and in all patients with bone infiltration. Myelograms were abnormal in 97% of 32 patients and showed a complete block in 63% of patients. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed the fat-density lesions in all cases studied. There was vascular enhancement in three of five cases with contrast-infused CT and in the one case with gadolinium-infused MR imaging. All patients improved following resection of the epidural lesions and internal decompression of the intramedullary lesions. It is concluded that spinal angiolipomas predominantly affect women. They involve the thoracic (especially the midthoracic) region, and produce symptoms and signs of spinal compression and, in some cases, bone erosion and pathological fractures. Their symptomatology can be exacerbated by pregnancy and weight gain, suggesting that vascular engorgement and the presence of obesity influence their evolution. Their preponderance in older, peri-, or postmenopausal women, and their clinical exacerbation in pregnant women support a role for hormonal influence. Magnetic resonance imaging is the investigation of choice for the diagnosis of these lesions. Surgery is universally successful in relieving symptoms.

Vertebral hemangioma symptomatic during pregnancy--report of a case and review of the literature

A spinal tumor complicating pregnancy is a rare condition. A 25-year-old woman who became paraplegic during the 35th week of her second pregnancy presented during the postpartum period. She underwent two surgical interventions, and the cord compression caused by a T5 vertebral body hemangioma with laminar involvement and extradural extension was relieved. The occurrence of vertebral hemangiomas during pregnancy is discussed; the radiological features with special reference to magnetic resonance imaging are outlined; and cases from the literature are reviewed.

Extradural spinal angiolipoma: report of a case studied with MRI

The current report describes a case of extradural angiolipoma with spinal cord compression that was studied by magnetic resonance imaging. In considering the strategy for the surgical management, it is desirable to determine the histologic type of spinal cord tumors before the operation. The literature of spinal angiolipoma is reviewed, and the possibility of using magnetic resonance imaging to define the histologic type of spinal cord tumors before operation is discussed.

Spinal epidural angiolipoma: rare or unreported?

Three cases of spinal epidural angiolipoma, all affecting middle-aged women, are reported. Spinal epidural angiolipomas are considered a separate entity from the more common lipomas involving the same space. Although these tumors are considered very rare, the occurrence of three cases in less than 2 years in the same geographical area raises the question of their frequency. The computed tomographic scan has been misleading in two of our patients, whereas magnetic resonance imaging was highly suggestive. Two of these tumors were apparently exceptional, being lumbar and anterior. The patients were admitted with typical sciatic symptoms; one tumor eroded the vertebral body. Spinal epidural angiolipomas may go unreported because their pathogenetic potential is not fully recognized. We suggest that both magnetic resonance imaging and the operating microscope should have a more significant place in the evaluation and treatment of sciatica.

MRI in the diagnosis of spinal extradural angiolipoma

We report the case of a 68-year-old woman with a 1-year history of progressive spastic paraparesis, due to an extradural angiolipoma of the mid-thoracic spine. The MRI appearance of the angiolipoma is reported here for the first time. This appearance is characteristic, allows preoperative diagnosis and assists planning of the surgical approach.