Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 8, 2014
Spinal Epidural Angiolipoma
- Spinal angiolipoma is a rare, benign, and usually non-infiltrating tumor that accounts for approximately 1% of all spinal tumors and 2%–3% of extradural spinal tumors. Spinal angiolipomas contain mature lipomatous elements and proliferating vessels, and these tumors have been suggested as an intermediate entity on a spectrum ranging from angiomas to lipomas.
- There is an infiltrating angiolipoma subtype which is extremely rare. These usually involve the extremities and may extensively infiltrate into the surrounding tissues, such as bones, muscles, nerves, and fibrocollagenous tissues. Spinal infiltrating angiolipomas are usually ventrally located.
- Clinical Presentation: Patients present with back pain, progressive unstable gait, paraparesis, and paresthesias of the lower limbs.
- Key Diagnostic Features:
- Heterogeneous extradual lesion, predominantly hyperintense on T1WI, with variable (but typically hyperintense) signal intensity on T2WI
- Fat-saturation sequences are helpful.
- Heterogeneous enhancement is seen following contrast administration.
- DDx:
- Lipomatosis
- does not enhance after contrast administration
- Metastases
- does not have fat signal
- usually invades bone and soft tissues
- Lymphoma
- does not have fat signal
- homogeneous enhancement
- bone and soft-tissue infiltration is common
- Neurogenic tumor
- usually well circumscribed
- rarely located solely in the posterior epidural space
- Lipomatosis
- Rx: Surgical resection
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