Epidural angiolipomas are rare benign tumors composed of mature adipocytes and abnormal vessels.
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Epidemiology
Epidural angiolipomas are more frequently encountered in women, and typically in middle age (40-50 years of age) 1.
Clinical presentation
In keeping with the slow growth of these tumors, clinical presentation is usually gradual with symptoms often present over a number of months/years. Signs and symptoms include:
- paraparesis
- back pain
- sensory changes (lower limbs)
- hyper-reflexia (lower limbs)
Radiographic features
Angiolipomas can be divided into infiltrating and non-infiltrating varieties, and both as seen in the epidural space. Non-infiltrating angiolipomas are more common and are usually located in the dorsal epidural space, typically in the thoracic region 1. Infiltrating angiolipomas are more common in the anterior epidural space, and can infiltrate not only adjacent soft tissues, but also adjacent vertebrae 1.
CT
CT demonstrates a mixture of soft tissue density and fatty components.
MRI
Signal characteristics are as expected from the composition of this tumor:
-
T1
- high signal fatty component
- intermediate signal vascular component
-
T2
- high signal
- flow voids are usually absent 1 but enlarged vessels in the region may be visible
-
T1 C+ (Gd)
- vivid enhancement of non-fatty components
Treatment and prognosis
Surgical resection is the treatment of choice, particularly for non-infiltrating tumors, in which case complete resection is possible and curative 1.
Malignant transformation has not been reported 1.
Differential diagnosis
Differential diagnosis includes other epidural masses 1:
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