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.