Spinal epidural angiolipoma: a case report on sudden hemorrhagic onset and review of the literature

Abstract

Spinal angiolipoma is composed of adipocyte and abnormal vascular elements [1]. It has an incidence of 0.04% to 1.2% among all spinal axis tumors and 2% to 3% among extradural spinal tumors [2]. Most spinal angiolipoma are expressed at the thoracic level and are associated with signs of cord compression as they enlarge slowly, therefore, a sudden deterioration in symptoms does not occur. However, hemorrhagic transformation of angiolipoma, although rare, may cause sudden worsening of neurological symptoms [3][4][5]. Unfortunately, it is difficult to differentiate these cases from simple hematoma. Herein, we report a case of hemorrhagic transformation of angiolipoma, in which we used dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the preoperative discrimination between the tumor and hematoma, and our surgical experience.Spinal epidural angiolipoma is an uncommon benign tumor composed of vascular and fat elements. Hemorrhagic transformation of angiolipoma is very rare, and only a few cases have been reported. Herein, we report a very rare case of the surgical removal of an angiolipoma that had undergone hemorrhagic transformation. On preoperative radiological studies, it was difficult to differentiate between a simple hematoma and a mass. Dynamic contrast-enhanced magnetic resonance imaging confirmed the presence of a hypervascular mass and total en bloc removal was planned. The patient underwent T3-5 laminectomy and tumor removal surgery, and his symptoms gradually improved.

Thoracic Spinal Angiolipoma: A Case Report and Literature Review

“…Spinal angiolipoma (SAL) occurs in approximately 0.04% to 1.2% of all spinal tumors 17,23,28,30,32,37) . SAL is a benign tumor made up of adipose tissues and vasculature 1,16,22,23,[27][28][29][30]32,34,35,38,39,42) .…”

“…Spinal angiolipoma (SAL) occurs in approximately 0.04% to 1.2% of all spinal tumors 17,23,28,30,32,37) . SAL is a benign tumor made up of adipose tissues and vasculature 1,16,22,23,[27][28][29][30]32,34,35,38,39,42) . Although the tumor is usually found within the thoracic epidural space, SAL is sometimes found within the lumbar epidural space.…”

“…Usually, SAL grows slowly and compresses the spinal cord or root, causing symptoms gradually 4,12,18,31,40,46) . SAL can be subdivided into two types, non-infiltrating and infiltrating 1,18,23,32,33,35,40) . The non-infiltrating type of SAL is easily dissected from the surrounding dura and adjacent tissue because it is encapsulated.…”

“…The non-infiltrating type of SAL is easily dissected from the surrounding dura and adjacent tissue because it is encapsulated. In contrast, the infiltrating type is not encapsulated, making total removal difficult 1,23,33,39,42) . Magnetic resonance imaging (MRI) has an important role in diagnosing SAL, but the gold standard for diagnosis is pathological diagnosis 1,4,18,23,32,38) .…”

“…In contrast, the infiltrating type is not encapsulated, making total removal difficult 1,23,33,39,42) . Magnetic resonance imaging (MRI) has an important role in diagnosing SAL, but the gold standard for diagnosis is pathological diagnosis 1,4,18,23,32,38) . The main treatment in SAL cases is surgical removal.…”