Infiltrating 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.

Thoracic Spinal Angiolipomas: A Systematic Review

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.

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.

Infiltrating spinal angiolipoma with paraplegia and hydrocephalus: A rare case report

Angiolipoma is a rare subtype of lipoma that contains both mature adipocytes and a rich vascular component. Infiltrating spinal angiolipomas causes surgical challenges with potential on-table injuries to adjacent structures. We present a rare case of infiltrating spinal angiolipoma in a 76-year-old woman who presented with paraplegia and hydrocephalus. At the time of presentation, the patient was bedridden for 3 months due to a complete loss of motor power. Imaging examination revealed a lesion involving the T6 vertebra with compressive myelopathy. The patient underwent spinal decompression and resection of the lesion, which turned out to be an infiltrating angiolipoma by histological examination. This is a unique case because spinal angiolipoma is extremely uncommon and such lesions generally manifest without infiltration. This case report highlights the existence and importance of spinal angiolipoma as a differential diagnosis of chronic backache resulting in neurological deficits and hydrocephalus.

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.

Infiltrating angiolipoma of the foot: magnetic resonance imaging features and review of the literature

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.

Angiolipoma on the Lumbar Spine

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.

Epidural spinal angiolipoma: a case series

Background

Spinal angiolipomas (SAL) are rare benign tumors, commonly presenting with slow progressive spinal cord compression. There are only about 170 cases identified so far. Magnetic resonance imaging (MRI) has become the modality of choice for SAL. The purpose of this article is to report three cases of SAL and their characteristic MRI features.

Case presentation

Three cases of epidual spinal angiolipoma from ethnic Han Chinese patients are presented here, including one lumbar and two thoracic tumors. MRI imaging findings were reviewed.

Conclusions

Multiple MRI technology for characterization of SAL provides useful information for differential diagnosis and therapeutic management.

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.

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.

Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis

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.