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Images in Neurology
July 2008

Spinal Cavernous Angiolipoma

Arch Neurol. 2008;65(7):981-982. doi:10.1001/archneur.65.7.981

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).