Angiolipoma thoracic spine
Lower limb weakness.
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An extradural mass extends dorsal to the theca from T3-T6 inclusive, resulting in significant compression of the upper thoracic cord, with impression of subtle increased T2 signal within the cord itself. The mass demonstrates heterogeneous T1 signal, with areas of intrinsic high T1 signal which appear to saturate fat sat post contrast imaging, very bright signal on T2, with vivid contrast enhancement. DWI demonstrates intermediate restricted diffusion. Numerous prominent vessels are seen in the interspinous spaces, as well as at the affected levels coursing through the foramina. The adjacent vertebrae are unremarkable, and there is no evidence of direct aggressive infiltration. The remainder of the scan is unremarkable in appearance.
Appearances are characteristic of an epidural angiolipoma. The fatty component is minor and this lesion is bound to be very vascular.
The patient went on to have a laminectomy and resection of the tumour.
An irregularly shaped piece of soft pink tissue 24x18x8mm and two irregular pieces of rubbery to soft dark brown-red tissue 55x20x15mm and 20x15x4mm.
The sections show a proliferation of small to medium-sized blood vessels. The endothelial cells show no nuclear atypia. No thrombosis is seen. In-between the blood vessels is increased amount of fat. The adipocytes are mature. No lipoblasts are seen. There is no evidence of malignancy. The features are those of angiolipoma.