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E1214. Spinal Angiolipomas: A Literature Review and Case Studies
Authors
  1. Lauren Larsen; Oregon Health and Science University
  2. Heather Burbank; University of Vermont Medical Center
  3. Christopher Filippi; Zucker School of Medicine at Hofstra/Northwell
  4. John DeWitt; University of Vermont Medical Center
  5. Matthew Wood; Oregon Health and Science University
  6. Joshua Nickerson; Oregon Health and Science University
Background
Spinal angiolipomas (SALs) are rare benign tumors composed of mature lipomatous tissue and blood vessels accounting for <2% of all spinal neoplasms. Etiology and pathogenesis are unknown but theorized to arise predominantly in the mid-thoracic region due to the decreased blood supply in the thoracic spine. They typically occur longitudinally in the dorsal epidural region. Magnetic resonance imaging (MRI) is the modality of choice, showing iso- or hyperintensity on T1 weighted imaging, enhancement on postgadolinium sequences, and hyperintensity on T2 weighted imaging. Total surgical resection provides complete symptomatic relief in most cases with a good prognosis and rare recurrence. While less common, it is important to consider this tumor on the differential diagnosis of spinal epidural lesions along with schwannomas, epidural hematomas and hemangiomas. We provide four example cases and a comprehensive review of the current and relevant literature pertaining to SALs.

Educational Goals / Teaching Points
1. Understand the clinical presentation of SALs 2. Interpret the appropriate modality for diagnosis of SALs 3. Recognize the key identifiers on pathology and gross tumor 4. Understand treatment options for SALs and recurrence rates 5. Appreciate four case studies demonstrating imaging characteristics of SALs

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging: MRI is the modality of choice, showing iso- or hyperintensity on T1 weighted imaging, enhancement on postgadolinium sequences, and hyperintensity on T2 weighted imaging. Typically found in the mid-thoracic region, longitudinally along the dorsal aspect of the spine.

Conclusion
We present four case studies and a comprehensive literature review of SALs, demonstrating the importance of considering these rare lesions on the differential of spinal epidural masses. Diagnosis and treatment of SALs is critical, given surgical treatment leads to a low recurrence rate and complete resolution of symptoms in most cases.