1
|
Hassan HA, Hassan HA, Ali RA, Omar DA, Salih AM, Kakamad FH. Multiple angiolipoma of the hand, back, and abdomen; a case report. Int J Surg Case Rep 2022; 93:106901. [PMID: 35298986 PMCID: PMC8927707 DOI: 10.1016/j.ijscr.2022.106901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Angiolipoma is a rare and benign variant of lipoma that usually occurs as single or multiple entities. The aim of this study is to present a case of multiple angiolipoma located in the hand, back, and abdomen. Case report A 38-year-old male presented with multiple swellings in his body for a 6-year duration. Physical examination revealed 3 painless masses in the hands, back, and abdomen. Laboratory findings were normal and ultrasound (US) examination suggested multiple body lipoma. The patient was managed with total excision and histopathological examination confirmed the diagnosis of benign angiolipoma. No reoccurrence was observed upon follow-up. Discussion Angiolipoma mainly composed of a mixture of proliferating blood vessels and mature adipose tissues, with a degree of vascularity much higher than that of a normal lipoma. It has a slow growing nature that it can be presented as single or multiple neoplasia. It is reported to be more common in the young adult population with male predominance. Conclusion Angiolipoma is a rare variant of lipoma. It rarely occurs in the hands, especially as a painless mass. Histopathology is required for definitive diagnosis. Angiolipoma is a rare and benign variant of lipoma. It mostly occurs as single or multiple entities in trunk and upper extremities. It is rarely reported in other areas, including the hands. This report presents a rare case of multiple angiolipoma of the hand, back, and abdomen.
Collapse
Affiliation(s)
- Hunar A Hassan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hemn A Hassan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Rebwar A Ali
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Diyar A Omar
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Medical Laboratory Technology, Shaqlawa Technical College, Erbil Polytechnic University, Erbil, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, Department of Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; College of Medicine, Department of Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq.
| |
Collapse
|
2
|
Umana GE, Visocchi M, Roca E, Passanisi M, Fricia M, Tranchina MG, Tomasi SO, Nicoletti GF, Cicero S, Scalia G. Thoracic Spinal Angiolipomas: A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:161-172. [PMID: 34929751 DOI: 10.1055/s-0041-1739217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spinal angiolipomas (SAs) are rare, benign tumors, representing 0.0004 to 1.2% of angiolipomas, usually located at the extradural and posterior thoracic level, with multimetameric extension. METHODS A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The authors searched on PubMed and Scopus databases for published articles with the Mesh term "spinal angiolipoma" and pertinent associations. Language restriction to English papers was applied. The authors also reported three emblematic cases of patients who underwent surgical resection of spindle-shaped (type IA) and dumbbell-shaped (type II) SAs between 2014 and 2020. RESULTS Of the 256 retrieved articles, 33 were included in the meta-analysis. These 33 studies, together with our 3 reported cases, included a total of 60 patients, 36 females (60%) and 24 males (40%), with a mean age of 53.12 ± 12.82 years (range: 12-77 years).T5 was the most represented level (22 patients). Usually, the localization of SA was extradural, with 53 patients suffering from spindle-shaped type IA SA (88.3%) and 7 patients from dumbbell-shaped type II SA (11.6%). Almost all patients underwent laminectomy (78.3%) and presented a full recovery of motor deficits (85%). Gross total removal (GTR) was performed in 93.3% of patients. The mean follow-up was of 22.71 ± 21.45 months (range: 2-80 months). There was no documented recurrence at follow-up magnetic resonance imaging in any of the patients. CONCLUSIONS SAs are rare, benign tumors with a great vascular component that presents a favorable outcome. GTR is the gold standard treatment and usually an adjuvant therapy is not required. Even infiltrative lesions, which are more complex, can be treated successfully with a good prognosis. Dumbbell-shaped SAs must be differentiated from schwannomas and meningiomas, and require different surgical techniques, given the profuse bleeding associated with the attempt of debulking. En block resection is the key to treat these common benign tumors with acceptable blood loss.
Collapse
Affiliation(s)
| | - Massimiliano Visocchi
- Department of Neurosurgery, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy.,Catholic University of the Sacred Heart Rome Campus, Roma, Italy
| | - Elena Roca
- Department of Neurosurgery, Head and Neck Surgery, Poliambulanza Foundation Hospitals, Brescia, Lombardia, Italy
| | - Maurizio Passanisi
- Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | | | | | | | | | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
| |
Collapse
|
3
|
Zhang X, Dong S, Wang G, Zhang H, Wang JJ, Wang G. Spinal Angiolipomas : Clinical Characteristics, Surgical Strategies and Prognosis. J Korean Neurosurg Soc 2021; 65:49-56. [PMID: 34823274 PMCID: PMC8752894 DOI: 10.3340/jkns.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Angiolipomas are usually found in the subcutaneous tissue of the trunk and limbs. Spinal angiolipomas (SALs) are uncommon and have rarely been reported. We report a series of nine SALs patients who received surgical treatment in our department. To summarize the clinical characteristics of SALs, propose our surgical strategies, and evaluate the effects of the operation.
Methods This was a retrospective review of nine SALs patients who received surgical treatment from August 2015 to March 2020. Total or subtotal resection was determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. The outcomes were assessed based on the modified Japanese Orthopaedic Association (mJOA) scoring system utilized before surgery and at various follow-up points.
Results Among the nine patients, the mean mJOA score before surgery was 6.6±2.3, compared with 10.1±1.1 at the last follow-up time point (33.4±11.8 months). All patients achieved good outcomes, even in cases of subtotal resection.
Conclusion Early surgical resection of SALs is recommended, and the specific procedures should be determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. Most of the patients had a good prognosis, even in cases of subtotal resection.
Collapse
Affiliation(s)
- Xiaolei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
4
|
Abstract
Spinal angiolipomas (SALs) are extremely rare benign tumors composed of both mature fatty tissue and anomalous vascular channels. We present two cases of SALs and review the clinical presentation, radiological appearance, pathological aspects, and treatment of this distinct clinicopathological mass. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence or neurological deficit. SAL should be considered as a differential diagnosis in patients with spinal cord compression. Magnetic resonance imaging is important for detecting and characterizing SALs. The gold standard treatment modality should be total resection.
Collapse
Affiliation(s)
- RuiDeng Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
5
|
Cheng Y, Lu K, Jiang H. Epidural angiolipoma with concomitant intradural extramedullary capillary hemangioma at the same spinal level: A case report. Oncol Lett 2020; 20:209-214. [PMID: 32565948 PMCID: PMC7286118 DOI: 10.3892/ol.2020.11559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Spinal epidural angiolipomas (SALs) and spinal intradural extramedullary capillary hemangiomas (SIECHs) are both types of rare benign tumor, and their pathogeneses appear to be associated. The present report is, to the best of our knowledge, the first case of spinal angiolipoma and intradural extramedullary capillary hemangioma occurring at the same spinal level. A 54 year-old male patient experienced two operations within four months due to the occurrence of SAL and one SIECH at the T3 level presenting with sudden paraplegia. Although the co-occurrence of SAL and SIECH at the same spinal level is an extremely rare condition, omitting the intradural tumor may be averted via scrutiny of preoperative images.
Collapse
Affiliation(s)
- Yongquan Cheng
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Kaiwu Lu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hui Jiang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| |
Collapse
|
6
|
Spinal angiolipoma: Presentation of two cases and review of the literature for the years 2012–2017. Neurocirugia (Astur) 2020; 31:76-86. [DOI: 10.1016/j.neucir.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/25/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
|
7
|
Spinal extradural angiolipomas: 7 new cases and review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Abstract
Spinal angiolipomas are benign tumors predominantly found in the epidural space. Infiltrating spinal angiolipoma is an extremely rare type, which tends to invade the surrounding tissue and may mimic an aggressive tumor. Herein, we reported the case of a 64-year-old woman with a thoracic angiolipoma involving the T9 vertebral body and its appendix. The lesion showed long T1 and T2 signal intensity on MRI and slightly increased FDG uptake on PET/CT. After surgery, the pathologic examination demonstrated features consistent with angiolipoma, and the patient was free of symptoms.
Collapse
|
9
|
Lacour M, Gilard V, Marguet F, Curey S, Perez A, Derrey S. Sudden paraplegia due to spontaneous bleeding in a thoracic epidural angiolipoma and literature review. Neurochirurgie 2018; 64:73-75. [PMID: 29472020 DOI: 10.1016/j.neuchi.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/06/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spinal angiolipomas are rare epidural tumours that are usually revealed by chronic symptoms of medullar irritation. We report a case of acute paraplegia caused by spontaneous bleeding revealing a thoracic angiolipoma. CASE DESCRIPTION A 17-year-old male patient with no previous medical history was admitted for acute onset of paraplegia with bladder retention and loss of sensation in the lower limbs, preceded by dorsal pain during the three previous days. MRI showed an enhanced T1-weighted image of a T7-T12 epidural lesion. The T1-weighted isosignal and the T2-weighted hyposignal suggested haemorrhagic complications. Due to a mass effect on the spinal cord, an emergency laminectomy was performed. Histopathological examination of the lesion revealed an angiolipoma with spontaneous bleeding. Clinical outcome was favourable after two months. CONCLUSION This case is one of the first to be reported, although the clinical presentation is similar to that of other rare reported cases of paraplegia due to spinal compression by tumoural bleeding.
Collapse
Affiliation(s)
- M Lacour
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | - V Gilard
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - F Marguet
- Department of Pathology, Normandie Univ, UNIROUEN, Inserm UMR 1073, Rouen University Hospital, 76031 Rouen, France
| | - S Curey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - A Perez
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France; Department of Neurosurgery, Normandie Univ, UNIROUEN, Inserm UMR 1073 Rouen University Hospital, 76031 Rouen, France.
| |
Collapse
|
10
|
Four cases of spinal epidural angiolipoma. J Clin Neurosci 2018; 48:243-244. [DOI: 10.1016/j.jocn.2017.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/22/2017] [Indexed: 11/18/2022]
|
11
|
Kang HI, Kim TW, Kim EJ, Park KH. Angiolipoma on the Lumbar Spine. KOREAN JOURNAL OF SPINE 2017; 14:112-114. [PMID: 29017310 PMCID: PMC5642094 DOI: 10.14245/kjs.2017.14.3.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
Angiolipomas are composed of mature adipose tissue and blood vessels. Spinal angiolipomas are rare benign tumors with a good prognosis, and most symptoms are due to progressive compression of the spinal cord and root. The treatment of choice is total resection without any additional therapy. We report a case of an epidural angiolipoma on the lumbar spine in a 69-year-old man with weakness of the lower extremities. Lumbar magnetic resonance images revealed a well-enhanced epidural mass. He underwent laminectomy, and the tumor was completely removed. Pathologic examination confirmed the tumor was an angiolipoma. The patient's symptoms gradually improved postoperatively.
Collapse
Affiliation(s)
- Hee Il Kang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Eun Ju Kim
- Department of Pathology, VHS Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| |
Collapse
|
12
|
Akyuva Y, Gonultas A, Karaaslan N, Gulciftci Dagci Z, Saglik S, Isyar M, Mahirogullari M. Lumbar Spinal Angiolipoma with Expanding Left Neural Foramen Mimicking Lumbar Schwannoma; Case Report and Review of The Literature. Open Neurol J 2017; 11:20-26. [PMID: 29151988 PMCID: PMC5678235 DOI: 10.2174/1874205x01711010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/09/2017] [Accepted: 08/09/2017] [Indexed: 01/30/2023] Open
Abstract
Aim To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature. Methods Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: "OR", "AND". On-line literature searches were conducted using the key words "lumbar angiolipoma", "schwannoma ", "spinal angiolipoma", "spinal cord", and "spinal canal". We compared this research with our patient. Results Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma. Conclusion The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression.
Collapse
Affiliation(s)
- Yener Akyuva
- Republic of Turkey, Ministry of Health, State Hospital, Department of Neurosurgery, 59100, Tekirdag, Turkey
| | - Aylin Gonultas
- Republic of Turkey, Ministry of Health, State Hospital, Department of Pathology, 59100, Tekirdag, Turkey
| | - Numan Karaaslan
- Namik Kemal University School of Medicine, Department of Neurosurgery, 59030, Tekirdag, Turkey
| | - Zehra Gulciftci Dagci
- Republic of Turkey, Ministry of Health, State Hospital, Department of Pathology, 59100, Tekirdag, Turkey
| | - Semih Saglik
- Republic of Turkey, Ministry of Health, State Hospital, Department of Radiology, 56100, Siirt, Turkey
| | - Mehmet Isyar
- Medicalpark Bahcelievler, Department of Orthopaedic and Traumatology, 34050, Istanbul, Turkey
| | - Mahir Mahirogullari
- Istanbul Memorial Health Group, Department of Orthopaedic and Traumatology, 34758, Istanbul, Turkey
| |
Collapse
|
13
|
Cultrera F, Cozzi F, Lofrese G, Riccioni L, Cataldi ML, Tosatto L. Spinal angiolipoma. J Neurosurg Sci 2017; 63:98-99. [PMID: 28884558 DOI: 10.23736/s0390-5616.17.04024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Francesco Cozzi
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
| | - Luca Riccioni
- Department of Pathology, Ospedale M. Bufalini, Cesena, Italy
| | - Maria L Cataldi
- Department of Neuroradiology, Ospedale M. Bufalini, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy
| |
Collapse
|
14
|
Carrasco Moro R, Gutiérrez Cierco JA, Martínez San Millán JS, Pian H, Martínez Rodrigo MA. Spinal extradural angiolipomas: 7 new cases and review of the literature. Neurologia 2017; 34:98-104. [PMID: 28081976 DOI: 10.1016/j.nrl.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We present our experience with the diagnosis and treatment of spinal angiolipomas (SAL). METHODS We used our database of surgical patients to gather epidemiological, clinical, diagnostic, treatment, and follow-up data from confirmed cases of SAL. Patients' functional status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score for thoracic myelopathy. RESULTS We included 7 patients with ages ranging between 42 and 63 years; 4 were women. Lesions in all patients were located in the thoracic epidural space; in 2 cases, lesions extended outside the spinal canal. The most frequent form of presentation was pain combined with progressive myelopathy; patients scored 5 to 9 points on the mJOA scale. Radiological findings varied; this variability clearly depended on the proportion of tumour components (cellular variant in one case, predominantly angiomatous in another, and myxoid in yet another case). Four cases displayed radiological signs of bone involvement. Surgery resulted in excellent mJOA scores except in one case (mJOA score of 10); no recurrences were detected during follow-up (periods ranging from 1 to 5 years). CONCLUSIONS Extradural SAL can present with highly variable radiological and clinical features. Surgery must be tailored to each individual situation according to tumour extension; in some cases, it may include spinal reconstruction. Surgery results in excellent outcomes regardless of preoperative functional status and it is associated with low recurrence rates, even in case of incomplete resection.
Collapse
Affiliation(s)
- R Carrasco Moro
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | | | - H Pian
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | |
Collapse
|
15
|
Shweikeh F, Sangtani A, Steinmetz MP, Zahos P, Chopko B. Spinal angiolipomas: A puzzling case and review of a rare entity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:91-96. [PMID: 28694590 PMCID: PMC5490357 DOI: 10.4103/jcvjs.jcvjs_23_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with spinal epidural abscesses (SEAs) may have a variable presentation. Such an infection has a typical appearance on magnetic resonance imaging (MRI) and enhances with gadolinium. We present a case that was a diagnostic challenge where pre- and intra-operative findings resulted in conflicting impressions. The mimicker was a spinal angiolipoma (SAL). The authors then provide a thorough review of this rare spinal neoplasm. A 55-year-old man presented with back pain, paresis, paresthesia, and urinary retention. MRI was indicative of a longitudinal epidural thoracic mass with a signal homogeneous to nearby fat, curvilinear vessels, and lack of enhancement. Although at emergent surgery, the lesion was found to contain abundant purulent material. Microbiology was positive for methicillin-resistant Staphylococcus aureus and consistent with SEA without evidence of neoplasia. While the imaging features were suggestive of an angiolipoma, the findings at surgery made SEA more likely, which were validated histopathologically. The diagnosis of SEA is often clear-cut, and the literature has reported only a few instances in which it masqueraded as another process such as lymphoma or myelitis. The case highlights SEA masquerading as an angiolipoma, and further demonstrates to clinicians that obtaining tissue diagnosis plays a crucial role diagnostically and therapeutically. SALs, on the other hand, are slow-growing tumors that can be infiltrating or noninfiltrating. They typically present with chronic symptoms and T1-MRI shows an inhomogeneous picture. Complete surgical excision is standard of care and patients tend to do well afterward.
Collapse
Affiliation(s)
- Faris Shweikeh
- Summa Health System, Northeast Ohio Medical University, Rootstown, USA.,College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Ajleeta Sangtani
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Michael P Steinmetz
- Department of Neurosurgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Peter Zahos
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Bohdan Chopko
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA.,Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| |
Collapse
|