Spinal angiolipomas: report of a case and review of the cases published since the discovery of the tumour in 1890.

Angiolipomas of the spinal canal are extremely uncommon benign neoplasms composed of mature lipomatous and angiomatous elements. A case of thoracic spinal extradural angiolipoma producing progressive spinal cord compression in a 54-year old housewife is presented and 74 previously reported cases in the world literature over a period spanning nearly one century from 1890 to the present are analysed. The 75 total cases (46 females and 29 males) ranged in age from 6 to 73 years (mean 42.7, SD 15.9; median 43). The angiolipomas were located in the extradural compartment in 72 patients and intradural compartment in 3; 14 of the extradural lesions infiltrated the surrounding bone (infiltrating subgroup). Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the fat-density lesions in all the cases that we studied. The findings indicate that spinal angiolipomas predominantly affect women. Their preponderance in peri- or postmenopausal women, and their fluctuating clinical course during the pregnancy support a role of hormonal influence on the development of the lesion. They often involve the thoracic region, and produce symptoms and signs of spinal compression and, in some cases, bone involvement. MRI is the investigation of choice for the diagnosis of these lesions. Non-infiltrating angiolipomas can usually be removed easily through a laminectomy, but infiltrating angiolipoma can be only partially resected. However, outcome is not worse in the infiltrating than in the non-infiltrating lesions and appears to be relatively independent of the completeness of the surgical removal. Subtotal resection usually provides substantial symptomatic relief, because these lesions are slow growing and do not undergo malignant transformation. The results of this review show that angiolipomas of the spinal canal have a good prognosis after surgical removal, even if infiltrating.     

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.     

Spinal angiolipoma: case report and review of the literature

Summary Spinal angiolipomas are rare lesions usually found in the epidural space of the thoracic spine. This report presents a case of and reviews the literature on this rare entity. The etiology, clinical presentation, imaging, and treatment are discussed. In 92 reported cases of spinal angiolipoma 56 occurred in women (61%), and 36 in men (39%). Mean age of occurrence is 42.9 years (range 10 days–85 years) with most patients presenting with slowly progressive symptoms of spinal cord compression. Most cases occur in the extradural compartment, and are of the non-invasive subtype. This rare clinical entity must be considered in the differential diagnosis of spinal epidural lesions. In most cases complete removal is possible, however, prognosis is good even for infiltrating lesions. Thus, one must not risk neurological damage to attain complete resection.     

Infiltrating spinal angiolipoma causing myelopathy: case report

We present a case of an infiltrating spinal angiolipoma demonstrating extension into the vertebral body and the spinal epidural space. The infiltration into the epidural space caused myelopathy. About 40 cases of spinal angiolipoma and angiomyolipoma have been reported; however, only a few cases have been the infiltrating type. The radiological findings were similar to those of vertebral hemangioma, but poor enhancement of the angiolipoma on contrast-enhanced computed tomographic scans differentiated between them. The infiltrating epidural tumor was removed, and the clinical symptoms improved remarkably. Total removal of the tumor and stabilization of the involved vertebral body using the anterolateral approach may be desirable when a diagnosis of angiolipoma or angiomyolipoma is confirmed preoperatively.     

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.     

Spinal angiolipoma

Summary A case report of a woman with spinal angiolipoma is presented, and it is stressed that spinal angiolipoma and spinal lipoma are two different clinicopathological entities which should be clearly distinguished.     

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

Extradural angiolipomas are rare tumors that can produce spinal cord compression. Two patients with thoracic spinal angiolipoma are presented that were treated with surgical resection and radiation. The histological and clinical features of the 18 previously reported cases of these tumors are discussed.     

Infiltrating spinal angiolipoma: a case report and review of the literature

Angiolipomas are rarely encountered in the spine. We report the case of a 47-year-old man with a thoracic angiolipoma involving the T9 vertebral body. A preoperative spinal angiogram confirmed a highly vascular neoplasm. The lesion was treated with endovascular embolization prior to a T9 corpectomy and resection of the epidural component of the tumor. At time of surgery, minimal blood loss occurred during resection of the vertebral body and the epidural mass. Pathologic examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the clinical, radiographic, and pathologic features of infiltrating spinal angiolipoma and discusses therapeutic management options.     

Infiltrating angiolipoma in the foot.

A case of infiltrating angiolipoma of the right lower extremity is reported. Angiolipomas are benign neoplasms of adipose tissue with a rich vascular component and are classified as either infiltrating or noninfiltrating. Noninfiltrating angiolipomas are seen in young individuals, present as painful, soft, subcutaneous nodules and are treated by enucleation. Infiltrating angiolipoma is a rare neoplasm with only 23 previously reported cases. These lesions are usually unencapsulated or rarely partially encapsulated and tend to infiltrate bony, neural, muscular, and fibrocollagenous tissue. Treatment of infiltrating angiolipomas is aimed at wide excision with radiotherapy indicated for cases of recurrence.     

Spinal extradural angiolipoma: a case report]

This 60-year-old man had been well until four years prior to admission, when he developed slowly progressive weakness of the lower extremities. On admission he was found to have a spastic paraparesis, sensory disturbance below the level of T10 and mild sphincter dysfunction. Conventional myelography and CT myelography demonstrated an epidural mass located from T5 to T8 vertebral level. MRI revealed that the epidural mass was fusiform and markedly enhanced by the contrast medium. Laminectomy was performed and a fibrous tumor red in color was subtotally removed. Histological findings were consistent with those of angiolipoma. Angiolipoma is a rare tumor in the central nervous system and is regarded as a clinical entity different from a spinal lipoma. Occurrence of angiolipoma in the central nervous system has been reported in 40 cases in the world literature. Thirty nine cases of them occurred in the spinal canal, especially in the dorsal epidural space of the thoracic region. The fusiform shape demonstrated in this case might also be characteristic of angiolipoma in this region.     

Abdominal Schwannomas: Case Report With Literature Review

Schwannomas are rare tumors that arise from Schwann cells in neural sheaths. They are commonly found in the central nervous system, spinal cord, or peripheral nerves of the body. Occasionally, they occur in the gastrointestinal tract, with the stomach being the most common site. However, colorectal and retroperitoneal schwannomas are very rare. Preoperative diagnosis is often difficult and definitive treatment entails surgical excision. We herein present 3 cases of intraabdominal schwannomas.     

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.     

Sudden onset of paraplegia caused by hemorrhagic spinal epidural angiolipoma. A case report

Spinal epidural angiolipoma is a rare benign tumor containing vascular and mature adipose elements. A slow progressive clinical course was mostly presented and rarely a fluctuating course during pregnancy. The authors report the original case of spontaneous spinal epidural bleeding resulting from thoracic epidural angiolipoma who presented with hyperacute onset of paraplegia, simulating an extradural hematoma. The patient was admitted with sudden non-traumatic hyperacute paraplegia during a prolonged walk. Neurologic examination showed sensory loss below T6 and bladder disturbances. Spinal MRI revealed a non-enhanced heterogeneous thoracic epidural lesion, extending from T2 to T3. A bilateral T2–T4 laminectomy was performed to achieve resection of a lipomatous tumor containing area of spontaneous hemorrhage. The postoperative course was uneventful with complete neurologic recovery. Histologic examination revealed the tumor as an angiolipoma. Because the prognosis after rapid surgical management of this lesion is favorable, the diagnosis of spinal angiolipoma with bleeding should be considered in the differential diagnosis of hyperacute spinal cord compression.

     

Intrarachidian lipomas. Observations on 4 cases and pathogenetic considerations

The Authors report 4 cases of spinal lipomas: 2 intradural, 2 completely intrarachidian extradural. The intradural lipomas observed were 2 cases in the lumbo-sacral area, both operated on by the partial removal of the lesion with very good clinical results; histologically they were found to be 2 fibrolipomas. The 2 cases of extradural lipomas, completely intrarachidian, were situated in the thoracic and lumbar areas. Both were operated on with very good results and it was possible to remove all the lesion. They were found to be an angiolipoma and a mature lipoma. On the basis of the literature, the Authors maintain that, for these cases of intradural lipoma, the disembryogenetic hypothesis (such as embryological ectopia) should be accepted as etiopathogenesis. They point out the nature and origin of extradural lipomas, arising in a site where adipose tissue is abundant, have never aroused interest on their origin, but they too can be considered malformative lesions of the hamartomatous type and not neoplastic lesions. These data are confirmed by the remarkable frequency in these cases of the mixed variety of lipoangiomato or angiomiolipomatosis. The Authors thus underline the importance of the relationship between the presence of a subcutaneous lipoma in cases of completely intrarachidian extradural lipomas to support the hypothesis of malformative origin.     

Extradural spinal angiolipoma

Two cases of extradural spinal angiolipomas are reported. The literature is reviewed and the entity of extradural spinal angiolipoma proposed. A tumor of adulthood, unassociated with bony changes, it occurs mainly in the mid-dorsal spine. Paraparesis progresses over a period of 1-2 years and may wax and wane with pregnancy or body weight changes. Characteristically, the tumor lies over the dorsal aspect of the dura, from which it may be peeled off easily. Its port-wine color contrasts strikingly with the contiguous epidural fat. A benign condition, it responds favorably to surgical excision.     

Spinal angiolipoma--case report

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.     

Spontaneous epidural hematoma due to cervico-thoracic angiolipoma

Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7–T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery.     

Spinal extradural angiolipoma

We report a case of spinal angiolipoma, causing paraplegia in a 38-year-old pregnant female. The tumour was excised and the patient made remarkable recovery. The role of pregnancy and its associated hormonal profiles on tumour growth is discussed.     

Spinal cord compression secondary to a thoracic vertebral osteochondroma

The authors describe a case of spinal cord compression due to an osteochondroma arising from the T-6 vertebral body in a patient with hereditary multiple exostoses. This 16-year-old boy presented with spastic paraparesis. Surgical decompression was followed by resolution of the neurological impairments. Osteochondroma is the most common bone tumor. The distribution of osteochondromas greatly favors the extremities and these lesions rarely arise in the vertebral column. Osteochondromas occur in 2 distinct clinical settings--as solitary or multiple tumors, the latter being often associated with hereditary multiple exostoses. Osteochondromas are more commonly found in the posterior elements of the vertebrae. Intraspinal presentation of these tumors is usually limited to the cervical regions, with few tumors reported in the thoracic vertebrae. Based on the presented case and literature review, the authors conclude that osteochondromas of the thoracic spine that cause myelopathy usually arise from the vertebral body and pedicle. Prompt and systematic radiological investigations are important in planning surgical management. Surgical excision usually yields good results.