A rare case report of infratentorial cisternal angiolipoma with review of literature

Angiolipomas are slow-growing benign mesenchymal-derived tumors consisting of mature adipocytes and thin-walled blood vessels. While the majority of angiolipomas are found in subcutaneous tissues, rarely there are case reports of intracranial lesions. We present a case of cisternal angiolipoma in a 10-year-old female. She presented with vague symptoms like dizziness without neurological deficits and radiological evaluation confirmed a left-sided infratentorial cisternal partially enhancing mass. She underwent craniotomy and had complete resection of the mass, which was histologically composed of mature adipocytes and blood vessels, consistent with angiolipoma. A review of the literature found only 18 cases of intracranial angiolipoma ever reported with our case representing the first case of infratentorial cisternal region.

Angiolipoma an Uncommon Breast Mass in Men: A Case Series

Angiolipomas are uncommon benign masses of the breast which are rarely described in the male breast. They do not have a typical mammographic appearance and can present with concerning features such as microcalcifications or irregular borders. Ultrasound is helpful in evaluating these masses most commonly appearing as oval, circumscribed, and hyperechoic. Clinical, radiological, and pathological information needs to be carefully evaluated as angiolipomas can be confused with malignant pathology. Three cases of angiolipomas of the male breast are reported in this study with mammographic, sonographic, and pathologic correlation.

Duodenal angiolipoma: a rare tumor causing recurrent upper gastrointestinal bleeding

Duodenal angiolipoma is a rare adipocytic tumor, with non-specific symptoms precluding an early diagnosis. We present a case of a 67-year-old female admitted due to upper gastrointestinal bleeding. The upper endoscopy and endoscopic ultrasound evaluation showed a subepithelial lesion in the third portion of the duodenum. Endoscopic excision was performed using a standard polypectomy technique after endoloop placement. Histopathology was compatible with duodenal angiolipoma. The authors highlight duodenal angiolipoma as a rare adipocytic tumor potentially causing gastrointestinal bleeding, which can be safely treated with endoscopic excision.

Cellular angiolipoma: a case report and review of the literature

Cellular angiolipoma is a rare subtype of angiolipoma, with vascular density approaching 95%. This case report describes a 55-year-old female that presented for treatment of a mass in her left breast that had been tender to slightly painful on palpation for nearly 2 years The patient underwent surgical excision of the mass, which was pathologically confirmed as a cellular angiolipoma. As of the 3-year follow-up, the patient reported no recurrence of the lesion. It is important to report this case and refresh knowledge of this and similar lesions to raise awareness of this diagnosis and treatment and improve future management of cellular angiolipoma cases.

A rare cause of upper gastrointestinal bleeding in an elderly female: gastric angiolipoma

A 83-year-old woman with previous history of gallstone was hospitalized with intermittent melena of 1-week duration. Gastroscopy showed a protuberant mass with thick pedicle and superficial ulcer measuring 3.0 × 4.0-cm in the lower gastric body (Fig. 1. A). Biopsy of the ulcer indicated chronic inflammation without evidence of malignancy. Abdominal contrast-enhanced computed tomography demonstrated a well-defined and mixed density mass with heterogeneous enhancement in the gastric body. The final diagnosis was gastric angiolipoma.

Clinical features and surgical outcomes of spinal epidural angiolipomas

To discuss the clinical features and surgical outcomes of spinal epidural angiolipomas. We retrospectively analyzed the medical records of patients with spinal epidural angiolipomas who were performed microsurgery between January 2003 and December 2017. The diagnosis of spinal angiolipomas was based on pathological criteria. Modified McCormick classification was applied to evaluate neurological function. There were 11 females and 9 males with ages ranged from 38 to 74 years. Fourteen lesions were located in the thoracic region, 4 in the lumbar, 1 in the lumbosacral, and 1 in the thoracolumbar region. Patients presented with nonspecific symptoms and the duration of symptoms ranged from 1 to 168 months with a mean 21.3 months. 11 cases exhibited isointense on T1-weighted imaging(T1WI) and hyperintense on T2-weighted imaging(T2WI). The other 9 cases exhibited hyperintense on T1WI and T2WI imaging. Gross total resection (GTR) was performed in 19 patients, and subtotal resection (STR) was performed in 1 patient. Postoperatively, all patients showed a recovery or improvement of neurological functions except the STR patient. There was no recurrence or regrowth of the residual lesions observed on magnetic resonance images (MRI). Usually, spinal epidural angiolipomas have two types of MRI manifestations depending on the ratio of fat to vessels. Total resection of spinal epidural angiolipoma is possible regardless of it is infiltrative or not. Postoperative radiotherapy is not recommended for subtotal resection patients. A favorable functional outcome can be expected if the patient performed early surgery.

A rare tumor of the male breast "angiolipoma" Case report and review of literature

AIM

Angiolipoma is uncommon lesion in the breast and has clinical importance due to the potential of confusion with malignant breast lesions. To date, there is no defined diagnosis and treatment algorithm for breast angiolipomas. We aim to contribute to the literature for the diagnosis and treatment of angiolipomas with this case report and literature review.

CASE REPORT

A 29-year-old male patient presented with a newly emerged palpable mass in the right breast. Physical examination revealed a palpable mass in the lower inner quadrant of the right breast without any presence of skin changes, nipple discharge or palpable axillary lymph nodes. The lesion was found to be 3 cm in diameter and showed minimal vascularization on Doppler Ultrasound examination. Surgical excision of the lesion was performed and the lesion was diagnosed as angiolipoma.

CONCLUSION

Angiolipomas of the breast in male are rare pathological entities and must always be considered during differential diagnosis, as it can be confused clinically, radiologically and pathologically with other lesions, especially with malignant lesions KEY WORDS: Angiolipoma, Breast, Male breast lesions.

Rare localization of angiolipoma in the gastrointestinal tract: a case series

Objective

Angiolipoma is a benign tumor that rarely occurs in the gastrointestinal (GI) tract. This case series was performed to increase clinicians’ understanding of the diagnosis and management of GI angiolipoma.

Methods

We evaluated the clinical presentations, diagnoses, and treatments of 3 patients with angiolipoma in the upper GI tract in our hospital and 27 cases reported in the literature.

Results

Among all 30 cases of GI angiolipoma, 2 originated in the esophagus, 4 in the stomach, 2 in the duodenum, 1 in the jejunum, 7 in the ileum, 1 in the cecum, 9 in the colon, 2 in the rectum, and 2 in both the duodenum and colon.

Conclusion

Angiolipoma of the GI tract may be more likely to occur in middle-aged and elderly men and be located in the ileum and colon. The clinical manifestations generally involve upper GI hemorrhage and lower GI pain and obstruction. Computed tomography and endoscopy may be effective diagnostic techniques, but postoperative histopathologic examination is still the gold standard. The management of angiolipoma in the GI tract depends on the size and type of lesion. Most cases in the present series were managed by complete surgical resection, after which no recurrence was found.

Microsurgical treatment for spinal epidural angiolipomas

Spinal epidural angiolipomas are rare lesions composed of mature lipomatous and angiomatous elements. In this paper, the authors review a surgical series of ten patients with epidural angiolipomas. All patients had performed preoperative and postoperative magnetic resonance imaging. The diagnosis of angiolipoma was based on pathology. All the follow-up data were obtained during office visits. There were 5 males and 5 females with a mean age of 53.6 years. One tumor was located in the cervicothoracic, six in the thoracic, and three in the lumbar spine. The most common symptom was progressive motor deficit. Gross total resection of the tumor was achieved in nine cases, and subtotal resection was obtained in one case. No recurrence or regrowth of the residual tumor was observed during a follow-up period of 50.8 months. At the last follow-up, 90% of patients experienced improvement in the neurological function. Epidural angiolipomas are benign but clinically progressive lesions. Early surgery should be performed to prevent irreversible neurological deficits. Postoperative radiotherapy is not recommended. The risk of long-term recurrence/regrowth of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected.

Solitary noninfiltrating angiolipoma on the finger, an unusual localization

Angiolipoma, a subtype of lipoma, is a benign adypocytic soft tissue tumor composed of mature adipose tissue and small vascular proliferations. This entity makes up 5-17% of all lipomas. The diagnosis is made by clinical and pathological examination, ultrasonography, and/or magnetic resonance imaging (MRI). It is generally an encapsulated tumor (noninfiltrative), but rarely has an infiltrative form. Angiolipoma mostly occurs on the trunk and extremities with male predominance. The forearm is the most frequent location for angiolipomas. It is very rarely seen on the fingers. Herein, we report a patient with solitary noninfiltrating angiolipoma on a finger. The patient was treated with surgical excision and no recurrence has been noted over one year of observation.

Sonographic Differentiation Between Angiolipomas and Superficial Lipomas

OBJECTIVES

The purpose of this study was to compare the sonographic findings of angio lipomas with those of superficial lipomas.

METHODS

Preoperative sonograms of 26 angiolipomas from 18 patients and 47 superficial lipomas from 43 patients that were confirmed by biopsy were reviewed retrospectively. The echo texture, echogenicity, internal echogenic stranding, vascularity, visualization of lateral and superficial-deep tumor capsules, shape, and tumor length, width, and length-to-width ratio were evaluated and compared between angiolipomas and superficial lipomas.

RESULTS

Angiolipomas frequently appeared as heterogeneous (19 of 26 [73.1%]), hyperechoic (23 of 26 [88.5%]), and ovoid (17 of 26 [65.4%]) masses with lesser visualized lateral tumor capsules (6 of 26 [23.1%]), whereas superficial lipomas appeared as homogeneous (36 of 47 [76.6%]), isoechoic (35 of 47 [74.5%]), and spindle-shaped (23 of 47 [48.9%]) masses with well-visualized lateral capsules (33 of 47 [70.2%]), and the differences were statistically significant (P < .001). Vascularity was seen in 4 angiolipomas (16.7%) and in no superficial lipomas (0%). The mean length and width ± SD of angiolipomas (2.2 ± 1.02 and 0.6 ± 0.27 cm, respectively) were smaller than those of superficial lipomas (4.2 ± 1.52 and 1.1 ± 0.51 cm), with statistical significance (P< .001). The other sonographic findings did not reveal statistically significant differences between the tumor types.

CONCLUSIONS

Sonography might help differentiate angiolipomas from superficial lipomas.

Angiofibrolipoma of the larynx: Case report and literature review

BACKGROUND

Angiofibrolipomas are one of the rarest variants of lipomas. Laryngeal origin of lipomatous tumors is also very rare.

METHODS

The nature and severity of symptoms depend on the location and the size of the laryngeal tumors. However, pedunculated of a 28-cm long tumor with the point of origin on the left arytenoepiglottic fold reached down to the esophagus and. in spite of slight dysphagia. remained asymptomatic for many years. In this case, a narrowing of the digestive tract was masked by an adaptation to the presence of a slowly growing mass.

RESULTS

After surgical removal of the tumor and 18-month follow-up, the patient remains asymptomatic. Nonetheless, taking into consideration a possibility of recurrence or malignance, a postoperative regular 5-year follow-up was recommended.

CONCLUSION

This case report illustrates the successful transoral resection of a polypoid-shaped angiofibrolipoma of the larynx. An easy and safe endoscopic procedure seemed to be successful in the case described.

[Sonographic appearance of benign subcutaneous nodules--including color Doppler sonography]

OBJECTIVE

Color Doppler sonography is used to distinguish malignant from benign subcutaneous nodules because many malignant tumors show an increased number of vessels. But benign lesions, such as inflammatory epidermal cysts, pilomatricomas, palmoplantar fibromatoses show vascular flow signals. We analyze diagnostic factors for subcutaneous nodules on the basis of ultrasonographic appearance including color Doppler sonography.

METHODS

We evaluated with sonography 79 subcutaneous nodules in histopathologically proven cases.

RESULTS AND DISCUSSION

The diagnostic findings for 28 epidermal cysts were increased posterior echo(sensitivity 77%, specificity 90%). Vascular flow signals were seen in 7 cases(25%). The signals were seen from periphery to adjacent zone of the mass. They were accompanied by inflammatory granulation tissues histologically. The percentage of blood flow may be related to the percentage of "ruptured" epidermal cysts. Pilomatricomas (n = 9) had internal echogenic foci or Doppler flow signals, and no posterior enhancement (sensitivity 89%, specificity 78%). Seven pilomatricomas showed Doppler flow signals in the mass. The percentage of flow signals is explained by the degree of internal echogenic foci because remarkable calcium deposits producing posterior acoustic shadowing prevent us from flow signals. Palmoplantar fibromatoses (n = 5) were ill-defined margins and showed internal vascularity with no posterior enhancement (sensitivity 80%, specificity 94%).

CONCLUSION

More benign lesions showed vascular flow signals than reported previously. We have to diagnose subcutaneous nodules referring to not only color Doppler but also gray scale sonography.

Prenatal sonographic diagnosis of tuberous sclerosis complex

We report the case of a male fetus with tuberous sclerosis complex (TSC), in whom multiple cardiac rhabdomyomas and renal angiomyolipomas were detected at 33 weeks by ultrasound with additional brain lesions detected on MRI, all confirmed after birth. DNA analysis of the TSC2 gene detected a de novo mutation in the TSC2 gene. Postnatal follow-up and neurological examination were normal, as were the results of Holter monitoring.

Capillary malformation associated with angiolipoma: analysis of 127 consecutive clinic patients

BACKGROUND

Capillary malformations (also known as port-wine stains) are low-flow vascular malformations of the skin that occur in 0.3% of neonates. Angiolipomas are subcutaneous, benign, usually multiple, lesions, composed of adipose tissue and blood vessels, which occur in young adults.

OBJECTIVE

The aims of this study were to determine whether there is an association between capillary malformations and angiolipoma, and to describe the characteristics of patients with this association.

METHODS

Prompted by our finding of an accompanying subcutaneous mass in a patient with capillary malformation, we reviewed the entire pool of 127 patients (71 women, 56 men; average age 22.2 years) attending the Rabin Medical Center (Petach Tikva, Israel) for treatment of nonfacial capillary malformations. All patients underwent a detailed history and comprehensive physical examination. Biopsy samples were taken from suspect lesions.

RESULTS

In addition to the index patient, four patients were found to have a subcutaneous mass beneath the capillary formation. Imaging and histologic studies identified the mass as an angiolipoma. All of the lesions were relatively refractory to pulsed dye laser or intense pulsed light treatment.

CONCLUSION

This unique report of an association between capillary malformation and angiolipoma is intended to raise the index of suspicion for underlying angiolipoma in clinicians treating patients with refractory nonfacial capillary malformations.

Intraventricular angiolipoma

We report a case of 50-year-old man who was presented with recurrent episodes of left sided hemiparesis. CT scan and MRI brain revealed a large intraventricular fatty lesion. Histopathological examination showed a picture of angiolipoma.

Fat poor renal angiomyolipoma: patient, computerized tomography and histological findings

PURPOSE

We reviewed our experience with fat poor cases of angiomyolipoma.

MATERIALS AND METHODS

The records of patients with angiomyolipoma, as determined by pathological study, from 1998 to 2004 were reviewed by recording patient demographics and outcomes. Fat poor cases were defined as the failure of imaging to demonstrate fat in a lesion. Computerized tomography and histological characteristics were assessed.

RESULTS

Histologically confirmed angiomyolipoma was found in 15 patients. Multiple lesions were found in 3 of 15 cases (20%). Of these 15 patients who underwent surgery 11 (73%) had unsuspected angiomyolipoma due to absent fat on computerized tomography and they underwent intervention for presumed renal cell carcinoma. Mean age +/- SD in this group was 54 +/- 15 years and 8 of 11 patients (73%) were female, of whom 4 (50%) had uterine fibroids. These lesions were found incidentally in 7 of 11 cases (64%). Operative complications developed in 2 of 11 patients (18%). Average maximal diameter on pathological evaluation was 3.2 +/- 1.3 cm (range 1.5 to 6). Nonenhanced computerized tomography was available in 7 of 11 cases, of which 3 of 7 (42%) showed hyperdense lesions and 4 of 7 (57%) showed isodense lesions. The percent of fat identified per high power field was less than 25% in 12 of 13 fat poor angiomyolipoma lesions (92%) compared to 2 of 4 classic lesions (50%) known to be angiomyolipoma before surgery (p = 0.04).

CONCLUSIONS

We suggest that a general definition of fat poor angiomyolipoma should be the failure of imaging to reveal fat within a lesion, thus, making it unsuspected at surgery. A pathological definition should be less than 25% fat per high power field, which to our knowledge is a formerly undefined quantity. Not all cases are hyperdense on nonenhanced computerized tomography. These lesions cannot be reliably identified by imaging and they should be managed like all enhancing renal masses.

Angiolipoma of the esophagus: a rare clinical dilemma

Benign tumors of the esophagus are a rare but diverse group of lesions. Although non-malignant in biology, their presence can cause significant morbidity, including dysphagia, bleeding, gastrointestinal obstruction, and even asphyxiation. Diagnosis is frequently made using radiographic and endoscopic means, even in the absence of definitive biopsy. If discovered early, endoscopic or minimally invasive techniques may be used to excise these lesions, with essentially 100% cure rates. However, if discovered late, open excision or even esophagectomy may be required. Angiolipoma represents perhaps one of the rarest of the benign entities to affect the esophagus, with only a few cases reported in the current literature. We present the case of an 85-year-old man who developed complete esophageal obstruction due to a large, pedunculated angiolipoma, requiring open surgical excision.

Long-term outcome of transcatheter embolization of renal angiomyolipomas due to tuberous sclerosis complex

PURPOSE

Complications from renal angiomyolipomas (AMLs) are common in patients with tuberous sclerosis complex (TSC) and tumors greater than 4 cm are more likely to cause symptoms. AMLs are the most common cause of death in adults with TSC. We present our long-term experience with transcatheter tumor embolization as a definitive treatment for AMLs due to TSC.

MATERIALS AND METHODS

A total of 16 patients with TSC between 7.5 and 47.2 years old with symptomatic or large (4 to 21 cm) AMLs underwent embolization. Followup consisted of periodic physician visits or telephone contacts and renal imaging.

RESULTS

The 16 patients underwent 18 treatment sessions to embolize 27 tumors. There were no intraoperative complications. The post-embolization syndrome occurred in 11 individuals but all responded to medical management. Two individuals had an arterial aneurysm within a tumor. The AML size decreased in the 13 patients who were imaged 3 months after treatment, and the 7 patients who were imaged 3 to 9 years after treatment have shown no tumor regrowth. No renal failure or hemorrhage has developed in patients following embolization.

CONCLUSIONS

Transcatheter embolization of symptomatic or large AMLs due to TSC prevents hemorrhage and renal loss. The treatment is minimally invasive, preserves renal function, and can be performed multiple times. All of the patients who underwent followup renal imaging after embolization showed decreased AML size, and none of the 16 patients has developed renal loss or renal insufficiency in these individuals. Embolization should be considered the initial treatment of choice for large or symptomatic AMLs.

Preoperative diagnosis of colonic angiolipoma: A case report

Angiolipoma, a common benign tumor mostly seen in the subcutaneous tissue, is a rare pathological condition in the gastrointestinal tract that is usually diagnosed postoperatively. In this case report, an angiolipoma was diagnosed preoperatively by imaging (including CT scans, abdominal echo, barium enema, and colonoscopy). This pathology was confirmed postoperatively. Computed tomography scan, abdominal echo, and barium enema images were presented.

Infiltrating spinal angiolipoma: a case report and review of the literature

Angiolipomas are rarely encountered in the spine. We report the case of a 47-year-old man with a thoracic angiolipoma involving the T9 vertebral body. A preoperative spinal angiogram confirmed a highly vascular neoplasm. The lesion was treated with endovascular embolization prior to a T9 corpectomy and resection of the epidural component of the tumor. At time of surgery, minimal blood loss occurred during resection of the vertebral body and the epidural mass. Pathologic examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the clinical, radiographic, and pathologic features of infiltrating spinal angiolipoma and discusses therapeutic management options.

Lumbar spinal angiolipomas: report of two cases and review of the literature

STUDY DESIGN

Case report and review of the literature.

OBJECTIVES

To describe two patients with angiolipoma in the ventral aspect of the lumbar epidural space, to discuss the clinical, radiologic, and surgical features of these lesions, and to review previously reported cases.

SETTING

Rome, Italy.

METHODS

Two cases, a 60-year-old man and a 54-year-old woman presented with lumbar-sciatic pain but with no abnormal neurological signs. Investigation (CT and MRI) demonstrated lumbar tumours.

RESULTS

Laminectomy and excision of the tumors were performed, and symptoms improved immediately.

CONCLUSIONS

Magnetic resonance imaging with suppression fat sequences allows the recognition of these lesions. The prognosis after surgical removal of spinal angiolipoma is favorable.

A case of paranasal sinus angiolipoma

OBJECTIVE

To present the first documented case of an angiolipoma of the maxillary sinus, our treatment of the patient, and the 1-year follow-up results. At the conclusion of the report, the reader should be able to discuss the incidence, treatment options, and long-term prognosis of angiolipomas of the paranasal sinuses.

STUDY DESIGN

A case study reporting on a single patient with the diagnosis of maxillary sinus angiolipoma.

METHODS

Review of diagnostic studies, the operative technique, and the patient's chart for the 1-year period after treatment.

RESULTS

The patient remains free of disease 1 year after definitive surgical treatment.

CONCLUSIONS

Angiolipomas are exceedingly rare in this location. The accepted treatment for this disease in other regions of the body consists of wide local excision with close follow-up. The extent of the disease found in this patient required a medial maxillectomy for en bloc resection. We would advocate such an approach for other physicians who are faced with a patient with this rare diagnosis.

Angiolipoma of the right inferior colliculus: a rare central cause of hearing loss and limb ataxia

Intracranial angiolipomas are rare entities and are infrequently symptomatic. These benign lesions are adherent to the surrounding neurovascular structures as they share the same blood supply, which limits their resectability, and impose a possibility of persistence of symptoms. However, due to recent advancements in the neuro-radiological fields and microneurosurgical techniques it has been possible to localise precisely and excise these lesions with low morbidity and mortality. The authors present an interesting rare case of intracranial angiolipoma of the right inferior colliculus situated in the quadrigeminal plate cistern. The patient had presented with ipsilateral hearing loss and upper limb ataxia. Interesting clinical findings, neuro-imaging studies and peroperative features are presented and discussed along with a brief review of the literature.

Atypical benign lipomatous tumors in the soft tissue: radiographic and pathologic correlation

This article describes the characteristic imaging findings and correlates them with the pathology in the nonfatty regions of benign atypical lipomatous tumors, which have different findings compared with typical lipomas and well-differentiated liposarcomas. For differentiating these tumors from typical lipomas and well-differentiated liposarcomas, it may be helpful to analyze nonfatty regions in benign atypical lipomatous tumors.

[Spinal epidural angiolipomas: a rare cause of spinal cord compression. A report of 8 cases and review of the literature]

Extradural spinal angiolipomas are rare benign tumors containing vascular and mature adipose elements. We report 8 cases of spinal epidural angiolipomas in 6 females and 2 males. In 7 cases, the clinical manifestation was a progressive spinal cord compression and one case had a regressive paraparesis mimicking a multiple sclerosis. In the 8 cases, the localization was thoracic with an extradural complete type of contrast block in 2 cases and partial in 5 cases. The myelo-CT achieved in 7 cases and the magnetic resonance imaging done at our last case revealed a fat-containing epidural tumor. The tumors were removed in all cases through a laminectomy with a successful outcome after an average of 9 years (range: 6 months-12 years). Sixty-seven similar cases in the international literature are reviewed. A total of 75 cases have been studied: 45 women and 30 men with a mean age of 46.3 years (range: 6-73), presenting a progressive spinal cord compression in 68 cases and in 7 cases a regressive paraparesis mimicking a multiple sclerosis. Myelography shows an extradural compression of the thecal sac. MRI is nowadays the imaging modality of choice for the diagnosis of these lesions. The surgical removal often easy of the epidural spinal angiolipomas permit a fast recovery. The etiopathogenesis of this process is still controversial between the dysembryogenetic and malformative hypothesis.

[Gastric tumors with fatty components. CT findings and differential diagnosis]

PURPOSE

To assess the role of CT in diagnosing and characterizing gastric fatty tumors.

MATERIAL AND METHODS

We reviewed the CT scans of 16 patients (8 men, 8 women, mean age 52 years) with gastric fatty tumors (11 lipomas, 3 liposarcomas, 1 angiolipoma, 1 teratoma) examined from 1990 to 1999. The differential diagnosis considered primary and secondary lipomatosis, carcinoma engulfing the perivisceral fat and thus mimicking a liposarcoma, mesenchymal gastric and primary peritoneal tumors.

RESULTS

Lipomas involved the fundus (7/11), the body (3/11), the antrum (1/11). Multifocality was found in one case. Lesions size ranged 25 to 65 mm (mean 35 mm). All the lipomas showed homogeneous structure with negative (-30 -100) HU values. A pseudocapsule was demonstrated in 7/11 cases. No infiltrative growth was demonstrated. The angiolipoma located in the fundus showed a vascular component with strong contrast enhancement. All the liposarcomas were bigger than 10 cm and there was a strong correlation between pathologic specimen and CT findings. The differentiated liposarcomas showed the classic heterogeneous fatty density; on the contrary the myxoid and the pleomorphic types showed an aspecific structure with necrotic/cystic changes, mostly demonstrated in the myxoid type. The teratoma was a solid mass with fatty, solid, necrotic and calcified components.

CONCLUSION

CT allows the diagnosis and characterization of gastric fatty tumors. The preoperative diagnosis of lipomas plays a major clinical role because it often makes surgery unnecessary.

Mediastinal dumbbell angiolipoma

Nonneurogenic dumbbell tumors are rare. This report describes the case of a 46-year-old woman with a symptomatic mediastinal dumbbell angiolipoma. The tumor was successfully resected using a single-stage procedure, combining a posterior microneurosurgical and thoracoscopic approach. The patient made an uneventful recovery and the neurologic symptoms improved immediately.

[Doppler power with contrast media in the characterization of renal masses]

PURPOSE

To report the results of a prospective study investigating the potentials of contrast-enhanced power Doppler in the diagnosis of expansive renal lesions.

MATERIAL AND METHODS

From 1997 to October 30, 1999, we studied 59 expansive renal lesions (28 malignant, 31 benign) in 48 patients (mean age 55 years, range 10-79) with power Doppler US before and after the administration of an echo-enhancing agent (Levovist, Schering AG, Berlin, Germany). We identified 5 patterns of vascular architecture of the lesions, both before and after contrast agent administration, following the classification by Jinzaki e Coll.

RESULTS AND DISCUSSION

Power Doppler US showed vascular structures in 34 patients. The administration of Levovist revealed vessels in 12/25 lesions which had none at baseline studies and in 6 cases vascularity was particularly evident. Color signals were enhanced in all the 34 vascularized lesions, which allowed better definition of vascular patterns. The characterization of vascular patterns with baseline power Doppler US helped improve diagnostic accuracy compared to gray-scale US (58% versus 32%) for hyperechoic lesions, complex cysts and pseudomasses. Independent of contrast agent administration, the integration of gray-scale and power Doppler modes increased diagnostic accuracy even further (76% correct diagnoses).

CONCLUSIONS

In our series, the US contrast agent did not increase the diagnostic accuracy of power Doppler in the differential diagnosis of hyperechoic renal lesions; conversely, Levovist can be advantageous for the characterization of suspected pseudomasses and complex cysts.

Angiolipoma of the posterior mediastinum with extension into the spinal canal: a case report

Angiolipoma is a rare benign soft tissue tumor, an unusual variant of lipoma, consisting of fatty and vascular components and located in the subcutis, usually in the trunk and extremities. We report a case of posterior mediastinal angiolipoma extending into the spinal canal and showing both fat and angiomatous features on CT scan.

Angiolipoma of the breast with microcalcification. Mammographic, sonographic, and histologic appearances

Angiolipoma of the breast is a rare benign fatty tumor that can be mammographically confused with breast carcinoma. We herein report such a case presenting as a partial obscured mass with microcalcification on mammogram. Sonogram revealed an encapsulated hyperechoic nodule with homogeneous internal echo. Microscopic evaluation revealed abundant adipose tissues with evidence of proliferating vessels and intravascular hyaline thrombi. To our knowledge, angiolipomas of the breast containing microcalcification secondary to intravascular thrombi had not been previously reported.

Radiological and histological findings in spinal intramedullary angiolipoma

We report an intramedullary angiolipoma with spinal cord compression studied by MRI, angiography and CT. Angiolipomas of the spine are rare benign tumours containing vascular and mature adipose elements. They are epidural in more than 90 % of the cases; only three cases of intramedullary angiolipoma are described. The clinical picture is nonspecific, but MRI and CT suggest the diagnosis.

Multiple hepatic angiolipomas: a case report and review of literature

Follow-up of two hepatic angiolipomas in a patient without evidence of tuberous sclerosis is reported. Initially, the lesions presented as homogenously enhancing masses, which were nearly isodense to normal liver tissue on plain CT scans. Focal nodular hyperplasia was assumed. One year later, fat was detected in the growing tumors and percutaneous core biopsy revealed hepatic angiolipomas. Natural history of these rare lesions is unknown, and this is to the best of our knowledge the first observation of fatty metamorphosis in such a benign, mesenchymal hepatic neoplasm.

[Exophytic renal angiolipoma versus retroperitoneal liposarcoma]

OBJECTIVE

To report a case of exophytic renal angiomyolipoma mimicking a retroperitoneal liposarcoma on magnetic resonance imaging.

METHODS

A large, palpable abdominal mass was incidentally discovered during routine physical examination in a 61-year-old, hypertensive woman. A CT scan disclosed a retroperitoneal mass, 17 cm in diameter, adjacent to the kidney. The MRI findings were diagnostic of liposarcoma. The tumor was resected en bloc.

RESULTS

The histopathological findings demonstrated angiomyolipoma.

CONCLUSIONS

Exophytic angiomyolipoma can mimic retroperitoneal liposarcoma on MRI.

Extradural spinal angiolipoma associated with bone lysis in a dog

An extradural spinal tumor was diagnosed in a 12-year-old Labrador retriever that was presented with a one-week history of paraparesis. Myelography indicated a deviation of the spinal cord to the right side at the level of the second lumbar (L2) vertebra. The difference in length measuring the left and right sides of the L2 vertebra suggested a fracture of the vertebral body. Severe bone remodeling and an extradural mass were seen on computed tomography (CT). Clinical, radiographical, and histological findings are described and considered homologous to extradural angiolipomas described in the human literature.

Clinics in diagnostic imaging (4). Renal angiomyolipoma with spontaneous perinephric haemorrhage

A 69-year-old Chinese woman presented with acute right-sided abdominal pain. Intravenous urogram and ultrasound demonstrated a fatty lower renal pole mass with a perinephric collection. The diagnosis of renal angiomyolipoma was confirmed by computerised tomography. The perinephric haemorrhage resolved with conservative treatment. The classification, clinical features and management of this entity is discussed. The role of imaging in diagnosis and follow-up of renal angiomyolipoma is emphasised.