Spinal epidural angiolipoma
Very slowly progressive thoracic myelopathy over years, with T6 sensory level by time of presentation.
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T2-T6 posterior epidural tumour. Tumour extends from right to left foramina, and causes mild expansion of bony canal and some of the foramina. There is anterior displacement and compression of spinal cord.
The tumour is heterogenous on T1 and T2 - predominalty dark on T1, mildly hyperintense on T2. Lower portion of tumour has more focal dark T1 and intermediate T2 areas. Some peripheral flow void seen, difficult to differentiate from normal epidural vessels. Tumour shows avid enhancement.
On more detailed analysis, there are internal fatty tissue, but not a dominant feature on first inspection.
Histology: Abundant ectatic thin-walled vessels with intervening mature adipose tissue in ratio varying between 1:2 to 2:3.
This is a rare benign tumour. Configuration is fairly characteristics - thoracic, posterior epidural, multiple levels, extends from left to right foramina, bony canal widening.
A pre-operative diagnosis, apart from relying on its shape and location, is possible if there is significant amount of fatty content. But if the tumour is highly vascular, the fat may not be as obvious, and tumour looks more like a nonspecific soft tissue tumour. As the vessels are of low flow characteristics, flow void is not commonly seen; but will be a helpful hint if present.
Features against other epidural lesions are:
- Not typical shape for meningioma or schwannoma; although the T2 characteristics in this case looks almost like mix zones of Antoni A and B fibres.
- Not enough fatty tissue to be lipoma or low grade liposarcoma. High grade liposarcoma is unlikely given the long history and bony remodeling.
- Not typical appearance for vascular malformation or bony lesions with extraosseous soft tissue mass.