INTRODUCTION

Spinal angiolipomas are rare benign lesions composed of mature lipocytes admixed with abnormal blood vessels. Spinal angiolipomas account for 0.14 % to 1.2 % of all spinal axis tumours, about 2-3% of extradural spinal tumours.' Magnetic Resonance Imaging (MRI) is the examination of choice for diagnosis. A case of histologically confirmed thoracic spinal epidural angiolipoma was reported.

CASE REPORT

This 38-year-old Moroccan man had numbness in both feet and leg weakness. He gradually developed progressive gait ataxia and incoordination.

Examination revealed spastic weakness of the legs, hyperreflexia, clonus of the left ankle, extensor planter responses, decreased sensation to pain and temperature below T11 level and decreased vibration sense in the feet. Plain x-ray of thoracic spine was normal. MRI demonstrated a mixed intensity, but mainly hyperintense, epidural tumour extending between T10 and T11 The dura and spinal cord were severely compressed and deplaced anteriorly to the left (Fig. 1 and 2).

Operation and postoperative course. A T9-11 laminectomy revealed the epidural space filled with a fatty, hypervascular cleavable tumour. The spinal cord was compressed and displaced anteriorly to the left. The mass was totally excised. Microscopic examination of the excised tumour showed mature adipocytes, with a multiple typical vessels varied in size from capillary to small veins. No mitotic figures were observed.

	Figure 1 — MRI sagittal view T1 showing mixed hyper and isointense signal of an epidural tumour. Thoracic epidural spinal angiolipoma.		Figure 2 — MRI sagittal view T2 showing hyperintense epidural tumour. Thoracic epidural spinal angiolipoma.

The patient was discharged from hospital 8 days later with markably improvement. He was able to walk with a cane. Fourth month after his surgery, the patient's myelopathic symptoms had resolved, and he was able to return to work.

CASE REPORT

Spinal angiolipomas are distinct, benign lesions composed of mature lipocytes admixed with abnormal blood vessels. 1,2 They account for 1.2% of all spinal axis tumours. They can be regarded as maldevelopment, neoplastic or hamartomatous diseases. The hypothesis of hamartomatous origin from primitive pluripotentiel mesenchymal cells is gaining wide acceptance.

Spinal epidural angiolipoma produce medullar compression. Sensory changes in the feet over period of months usually progress to lower-extremity weakness and spasticity, with sphincter dysfunction in the later stages. About 22% of females are initially symptomatic during the last trimester of pregnancy, and coincides with the history of weight gain. 1-3 At the time of diagnosis, most patients show paraparesis with hyperreflexia, bilateral extensor plantars, with loss of pain, temperature, vibration, and position sensation .2,4,5,6

Spinal epidural angiolipomas predominantly affect women. The symptomas can be exacerbated by pregnancy and weight gain, suggesting that vascular engorgement and presence of obesity influence their evolution. Their preponderance in older, peri-, or postmenopausal women and their clinical exacerbation in pregnant women support a role of hormonal influence.1

Plain radiographs are abnormal in 39%. The bone involvement includes erosion of the pedicles or vertebral bodies. Most lesions involve the midthoracic region. Myelogram is abnormal in 39%, and shows a complete block in 63% of the patients. CT scan shows a hypodensity consistent with a fatty mass. Contrast show enhancement of the epidural angiolipoma. The MRI demonstrates a fatty mass with an abundant vascular component suggesting the diagnosis. The mass is hyperintense on T1 than T2-weighted signals, but can also be heterogeneous mixed intensity. CT and MR imaging shows the fat density lesions in most cases. With the widespread availability of MRI spinal angiolipomas are likely to be diagnosed more frequently.7-9

The treatment is surgical. Non-infiltrating extradural angiolipomas can be totally resected. Infiltrating angiolipomas may be more difficult to remove entirely, especially if they are anterior or anterolateral in location. It may then be necessary to undertake a staged removal, including an anterolateral approach with spinal stabilisation.5,7

Total or near total recovery is often possible in non-infiltrating extradural angiolipomas. 10 Patients in whom the spinal angiolipoma is only partially resected should be informed that a substantial weight gain or pregnancy might aggravate symptoms.

REFERENCES

1.	Preul M. C., Richard leblanc, Donatella Tampien, Yves Robitaille, Ronald Pokrupa. Spinal anpolipomas. Report of three cases. J Neurosurg, 1993, 78:280-286.
2.	Bender JL, Van Landingham JH, Manno NJ: Epidural lipoma producing spinal cord compression. Report of two cases. J Neurosurg, 1974, 41:100-103.
3.	Haddad FS, Abla A, Allam CK: Extradural spinal angiolipoma. Surg Neurol,1986, 26: 473-486.
4.	Greibel RW, Khan M, Rozdilsky B: Spinal extradural angiolipoma. A case report and literature review. Spine, 1986,11: 47-48
5.	Rivkind A, Margulies JY, Lebenstart P, et al,: Anterior approch for removal of spinal angiolipoma. A case report. Spine, 1986, 11: 623-625
6.	Pasquier B, Vasdev A, Gasnier F, et al,: L'angiolipome epidural: cause rare de compression de la moelle epiniere. Ann Pathol, 1984, 4:365-369.
7.	Trabulo A, Cerqeuira L, Monteiro J, Roqlle P, Reis FC, Coelho MR. Spinal angiolipomas revisited: two case reports. Acta Neurochir (Wien),1996,138 (11).1311-1319.
8.	O'Donovan NA, Naik K, Maloney WJ, Llewellyn CG. Spinal angiolipoma mimicking extradural lipomatosis. Can Assoc. Radiol J, 1996, 47(1): 51-53.
9.	Provenzale JM, McLendon RE. Spinal angioilpomas MR Features. Am J Neuroradiol, 1996,17(4): 713.
10.	Bouramas D, Korres DS, Roussos L, Mantzilas T, Anagnostopoulos D. Spinal extradural angiolipoma. J Spinal Desord,19°5, 8(4): 324-327.