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Images in Neurology |

Spinal Cavernous Angiolipoma

Muhammad U. Farooq, MD; Ranji Samaraweera, MD; Timothy Heilman, DO; Howard T. Chang, MD, PhD
Arch Neurol. 2008;65(7):981-982. doi:10.1001/archneur.65.7.981.
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A 57-year-old woman presented with a 6-month history of progressive worsening of back pain as well as numbness from below her bra line and extending distally, involving her abdomen and bilateral lower extremities. There was no associated motor weakness or bladder or bowel incontinence. Magnetic resonance imaging showed a heterogeneous T1-hypointense and T2-hyperintense mass within the epidural space, dorsal to the spinal cord and extending from the lower portion of T5 to the upper part of T8 (Figure 1). A thoracic decompressive laminectomy was performed to resect this mass en bloc. The tumor, focally covered with blood, grossly appeared to be a well-circumscribed soft and lobulated mass, measured 6.4 × 2.6 × 1.0 cm, and was attached posteriorly to the bony wall of the spinal canal (Figure 2A). The cut surfaces of the soft tumor appeared dark red, hemorrhagic, spongy in the middle (Figure 2B), and more fatty near the ends. The tumor did not appear to infiltrate the bone parenchyma. Histopathological analysis showed clusters of thin-walled large vessels consistent with cavernous hemangioma (Figure 2C). Scattered mature fat cells were seen between the vessels near the middle of the tumor (Figure 2D). In contrast, both the proximal and distal ends of the tumor predominantly consisted of adipose tissue with scattered smaller vessels, features consistent with angiolipoma (Figure 2E).

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Figure 1.

Magnetic resonance images in sagittal (A) and axial (B) views show a T2-bright extradural tumor (arrows) compressing the thoracic spinal cord.

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Figure 2.

Gross photographs in sagittal (A) and horizontal (B) sections show the spongy vascular tumor attached to the posterior wall of the spinal canal. A, Dashed line marks the boundary between the tumor and the vertebrae. Note the resemblances to the magnetic resonance images in Figure 1. C, Histological analysis shows that the tumor is attached to but does not invade the inner surface of the spinal canal. White arrow indicates the border between the tumor and the ligamentum flavum; black arrow, the border between the ligamentum flavum and the bone posteriorly (hematoxylin-eosin, original magnification ×40). D, The central portion of the tumor consists of mostly angiomatous components (hematoxylin-eosin, original magnification ×200). E, The distal ends of the tumor consist of mostly lipomatous components (hematoxylin-eosin, original magnification ×200).

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