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

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.

Thoracic spinal angiomyolipoma: case report from an Ethiopian neurosurgical teaching hospital. Illustrative case

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.

A rare case report of sacral epidural angiolipoma: Diagnosis and treatment

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.

Spinal Angiolipomas : Clinical Characteristics, Surgical Strategies and Prognosis

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.

An intraspinal extradural lipoma with spinal epidural lipomatosis: A case report and a review of literature

Background:

Intraspinal extradural lipomas are very rare and should be differentiated from spinal epidural lipomatosis (SEL) and/or angiolipomas.

Case Description:

A 76-year-old male presented with left lower extremity radiculopathy. The magnetic resonance imaging (MRI) revealed hyperplasia of epidural fat at the L2–3 and L3–4 levels accompanied by a lipomatous L4–5 mass. Following resection of this mass and hyperplastic epidural fat, the histological examination was consistent with an intraspinal extradural lipoma and SEL.

Conclusion:

This case indicates that asymmetrical compression of the dural sac may be attributed to an intraspinal extradural lipoma vs. just SEL and/or an angiolipoma.

Spinal angiolipomas: A puzzling case and review of a rare entity

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.

[Lumbar spinal angiolipoma]

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.

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.

Radiculopathy in the setting of lumbar nerve root compression due to an extradural intraforaminal lipoma: a report of 3 cases

A true adult spinal lipoma is an exceedingly rare cause of lumbar compression neuropathy. Only 5 cases of true extradural intraforaminal lipomas have been documented in the medical literature. The diagnostic criteria and treatment guidelines for this specific lipoma have yet to be established. This report features 3 histologically confirmed cases of extradural intraforaminal spinal lipomas that recently presented to the authors’ practice. In addition, the literature was surveyed to include the 5 previously reported cases of true adult extradural intraforaminal spinal lipomas. The consistency in presentation, response to surgical intervention, and postoperative recovery in these 8 cases supports surgical intervention at the time of diagnosis. The authors’ findings support elevated clinical suspicion, efficient diagnosis based on MRI, and early surgical intervention for this rare pathological entity. All cases presented in this report were symptomatic and occurred in the absence of other significant pathologies such as general spinal epidural lipomatosis, intradural lesions, tethering, or severe degenerative stenosis or herniated discs. The clinical, neuroradiological, and histological findings characteristic of a true adult extradural intraforaminal lipoma are emphasized to differentiate this lesion from the more common etiologies for lumbar compression neuropathy. Heightened awareness and clinical suspicion for the focal, foraminal spinal lipoma as a cause of radiculopathy symptoms will enable more efficient diagnosis and treatment.

Thoracic epidural angiolipoma: A case report and review of the literature

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.

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 nerve root compression due to extradural, intraforaminal lipoma. An underdiagnosed entity?

Intraspinal extradural lipomas, not associated with spinal dysraphism, are rare lesions. True adult lipomas have to be distinguished from angiolipomas and from epidural lipomatosis. The authors report a unique case of a patient with unilateral lumbar nerve root compression caused by extradural, intraforaminal, true adult lipoma. A 62-year-old woman suffered severe left L-5 radiculopathy that progressively worsened during the 12 months prior to presentation. She did not experience improvement with conservative therapy. An MR imaging study of the lumbar spine revealed shifting of the left L-5 nerve root caused by a small extradural intrarecessal (that is, the beginning of the intravertebral foramen)/intraforaminal mass with MR imaging characteristics of fatty tissue. No other relevant intraspinal pathology could be identified. A left L4-5 fenestration was carried out. A small fatty intrarecessal/intraforaminal mass compressing severely the left L-5 root was identified and completely resected. The histological examination revealed a lipoma. The patient recovered completely and is fully mobile and symptom free 1 year after the operation. Intraspinal lipomas should be considered in cases of radiculopathy, especially in the absence of relevant degenerative or tumorous pathology and in the presence of nerve root shifting caused by fatty tissue.

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.

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.

Lumbar spinal extradural angiolipomas. Two case reports

Spinal extradural angiolipomas are benign tumors mostly localized in the thoracic region. A 50-year-old woman and a 36-year-old man presented with rare lumbar spinal angiolipoma manifesting as low back pain but without neurological signs. Magnetic resonance imaging showed lumbar extradural tumors at the L4-5 and L1-2 levels, respectively. Each patient underwent complete surgical resection of the epidural tumors. Histological examination revealed characteristics of angiolipomas in both tumors. The symptoms of both patients improved postoperatively and no recurrence of the tumors was found 1 year after surgery.

Lumbar spinal angiolipoma: case report and review of the literature

Spinal angiolipomas are extremely rare benign tumors composed of mature lipomatous and angiomatous elements. Most are symptomatic due to progressive spinal cord or root compression. This article describes the case of a 60-year-old woman who presented with a 6-month history of low back pain radiating to her right leg. The pain was multisegmental. The condition had worsened with time. Lumbar magnetic resonance imaging revealed a dorsal epidural mass at L5 and erosion of the lamina of the L5 vertebra. Laminectomy was performed, and an extradural tumor was totally excised. Neuropathologic examination identified it as a lumbar spinal angiolipoma. There was no evidence of recurrence in follow-up 12 months later. This rare clinical entity must be considered in the differential diagnosis for any spinal epidural lesion.