Epidural thoracic spinal angiolipoma: Removed with favorable outcome.

BACKGROUND

Spinal angiolipomas are rare benign epidural tumors accounting for 0.14-1.2% of all spinal neoplasms. Pathologically, these lesions are composed of mature adipose tissue and contain proliferative vascular elements. Here, a 44-year-old female presented with a thoracic epidural angiolipoma causing progressive myelopathy, which was diagnosed and effectively managed, resulting in a good clinical outcome.

CASE DESCRIPTION: A 44-year-old female presented with a 7-month history of progressive thoracolumbar pain radiating into the lower extremities, accompanied by bilateral paraparesis (Medical Research Council scale [MRC] 4/5), symmetric hyperreflexia, and a T8-T9 sensory level to pin appreciation, along with impaired vibration/proprioception (Nurick Grade 3; Modified Japanese Orthopaedic Association scale [mJOA] score 11/18). The magnetic resonance imaging demonstrated a T7-T8 epidural mass with heterogeneous T1 signal and T2 hyperintensity that homogeneously enhanced with contrast, causing significant spinal cord compression and intramedullary high signal. Through a T7-T8 decompressive laminectomy, gross total tumor resection from T6 to T9 was accomplished; additionally, a T6-T9 posterior instrumented fusion was performed. Histopathology confirmed a non-infiltrating epidural angiolipoma. Three months postoperatively, the patient's ability to ambulate continued to improve.

CONCLUSION

Spinal angiolipomas should be considered amongst the differential diagnoses of spinal epidural masses, particularly in middle-aged women presenting with progressive myelopathy. Notably, early surgical decompression with gross total tumor resection offers an excellent prognosis.