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Journal of Craniovertebral Junction and Spine
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Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 91-96

Spinal angiolipomas: A puzzling case and review of a rare entity

1 Summa Health System, Northeast Ohio Medical University; College of Medicine, Northeast Ohio Medical University, Rootstown, USA
2 College of Medicine, Northeast Ohio Medical University, Rootstown, USA
3 Department of Neurosurgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
4 Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
5 College of Medicine, Northeast Ohio Medical University, Rootstown; Department of Neurosurgery, Stanford University, Palo Alto, CA, USA

Correspondence Address:
Faris Shweikeh
College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcvjs.JCVJS_23_17

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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.

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