Epidural angiolipoma

Case contributed by A.Prof Frank Gaillard

Presentation

Minor back pain for investigation.

Patient Data

Age: 60 years
Gender: Female
Modality: MRI

An extradural mass dorsal to the theca and cord extends from T2-T6, anteriorly displacing and moderately compressing the spinal cord, heterogeneous but predominantly T1 hyperintense, T2 hyperintense, and vividly contrast enhancing (best shown on the sagittal fat-saturated post contrast images). The lesion extends into the exit foramen at both T4/5 and T5/6, but no direct involvement of bone is shown and no bony destruction. The overall extent of the lesion has not altered.

Although there is complete effacement of CSF at the central component of the tumour, the cord demonstrates normal signal intensity.

Conclusion:

The lesion in the epidural space at the dorsal theca causing cord compression contains fat and also demonstrates prominent contrast enhancement. The shape, dorsal epidural location in a middle aged female are characteristic for angiolipoma.

Modality: Pathology

The patient went on to have a laminectomy and resection of the mass. 

MICROSCOPIC DESCRIPTION: 

The sections show features of angiolipoma in each of the nine specimens submitted. Each specimen shows thin-walled vascular channels of varying calibre lined by unremarkable endothelial cells, These are haphazardly dispersed within mature adipose tissue. Foci of non-specific chronic inflammation are also noted.  There is no evidence of malignancy in any of the specimens submitted. 

DIAGNOSIS: angiolipoma

Case Discussion

The imaging appearances in this case are very characteristic of an epidural angiolipoma, with no other differential being a realistic possibility. This was subsequently proven histologically. 

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Case Information

rID: 33244
Case created: 5th Jan 2015
Last edited: 23rd Jun 2016
Inclusion in quiz mode: Included

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