Multilevel thoracic spinal epidural angiolipoma.

Background: Spinal epidural angiolipomas (SEAL) are rare benign tumors composed of mature adipose tissue and abnormal blood vessels. SEALs account for 0.04-1.2% of all spinal tumors and 2-3% of spinal extradural lesions. They are usually found in the mid-thoracic dorsal extradural region. Here, we present the case of a 52-year-old female with a rare SEAL involving multiple thoracic levels. Case Description: A 52-year-old female presented with mid-thoracic pain and paraparesis (motor strength 3/5 proximal/distal). Magnetic resonance imaging (MRI) documented a well-demarcated, homogeneous dorsal epidural mass extending from T7 to T10. She underwent a laminectomy for tumor resection and decompression. The tumor, measuring 6 × 2 × 0.5 cm, consisted of mature adipose tissue and abnormal blood vessels. Postoperatively, the patient's motor deficit fully resolved within 6 months. Conclusion: SEAL is a rare extradural dorsal thoracic spine tumor that can be readily diagnosed with MRI. The gold standard of treatment is gross total resection through a laminectomy.

Angiolipoma associated with antiretroviral switch therapy: a case report.

BACKGROUND: Angiolipomas have been well described in patients with HIV exposed to protease inhibitors with possible resolution after switching to non-nucleoside reverse transcriptase inhibitor-based regimens. Resolution of symptoms have occurred with switches to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens; however, little is known regarding the development of angiolipomas when switching from NNRTI- to modern, integrase strand transfer inhibitor-based regimens. We describe a patient who underwent switch therapy from tenofovir disoproxil fumarate/emtricitabine/efavirenz (TDF/FTC/EFV) to tenofovir alafenamide/FTC/bictegravir (TAF/FTC/BIC) who later developed angiolipomas. CASE PRESENTATION: A 55-year-old male had been on TDF/FTC/EFV for 8 years before switching to TAF/FTC/BIC. Nineteen months after antiretroviral switch, the patient presented with multiple lesions in the upper extremities and abdomen. Diagnostic biopsies revealed non-encapsulated angiolipomas and HHV-8 and non-alcoholic fatty liver disease was ruled out. New lesions continued to appear 29 months after ART switch, after which now lesions appeared and prior lesions remained stable with no increase in size noted. No surgical intervention or change in antiretroviral therapy was needed. CONCLUSIONS: Angiogenesis may have been suppressed with TDF/FTC/EFV treatment, however when switched to TAF/FTC/BIC, promoted the growth of angiolipomas. Clinicians should be aware of the impact of switching to modern ART therapies resulting in possible adipogenesis.

Acute presentation of Wunderlich syndrome in a pregnant woman treated with supra-selective cannulation of renal segmental arteries and nephrectomy: A case report.

Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.

Colonic Angiolipoma: A Rare Cause of Chronic Anemia and Rectal Bleeding.

Angiolipomas are rare, benign tumors characterized by a mixture of adipose tissue and blood vessels, distinguishing them from lipomas. This case involves a 52-year-old woman with no significant medical history who presented with generalized weakness, fatigue, and intermittent, painless rectal bleeding over six months, initially dismissed as hemorrhoidal. Despite exhibiting mild pallor and trace rectal bleeding upon examination, significant iron-deficiency anemia was diagnosed through laboratory tests. Incorporating colonoscopy and computed tomography, the diagnostic process identified a 2 cm submucosal lesion in the ascending colon, characterized as a well-defined, fat-density mass. Histopathological analysis following surgical resection confirmed the diagnosis of a colonic angiolipoma. The patient's recovery, marked by the resolution of symptoms and normalization of hemoglobin levels, underscores the effectiveness of surgical treatment. This case highlights the diagnostic challenges posed by colonic angiolipomas due to their nonspecific symptoms. It emphasizes the importance of considering such rare entities in the differential diagnosis of gastrointestinal symptoms. This approach facilitates prompt and appropriate treatment, enriching the limited literature and advocating for clinical vigilance and interdisciplinary diagnostic strategies.

KTP-532 Laser Assisted Excision of a Rare Laryngeal Angiolipoma: A Case Report with Review of Literature.

Angiolipoma is a benign mesenchymal tumor and its occurrence in head and neck region is very rare. Only 2 cases of Laryngeal angiolipomas have been reported in the medical literature. We present one such rare case in a 32-year-old male who presented with complaints of change in voice and foreign body sensation in the throat since past 9 months along with features suggestive of obstructive sleep apnoea and dysphagia. Contrast enhanced CT scan of the neck showed a cystic lesion arising from right ventricle extending superiorly till the vallecula, partially obstructing the airway. Suspecting a supraglottic cyst, trans-oral microlaryngoscopic KTP-532 laser assisted excision was planned, intraoperatively a solid tumor was encountered. We discuss herein the clinical presentation and management of this rare neoplasm with review of literature.

Angiolipoma an Uncommon Breast Mass in Men: A Case Series.

Angiolipomas are uncommon benign masses of the breast which are rarely described in the male breast. They do not have a typical mammographic appearance and can present with concerning features such as microcalcifications or irregular borders. Ultrasound is helpful in evaluating these masses most commonly appearing as oval, circumscribed, and hyperechoic. Clinical, radiological, and pathological information needs to be carefully evaluated as angiolipomas can be confused with malignant pathology. Three cases of angiolipomas of the male breast are reported in this study with mammographic, sonographic, and pathologic correlation.

A rare case report of infratentorial cisternal angiolipoma with review of literature.

Angiolipomas are slow-growing benign mesenchymal-derived tumors consisting of mature adipocytes and thin-walled blood vessels. While the majority of angiolipomas are found in subcutaneous tissues, rarely there are case reports of intracranial lesions. We present a case of cisternal angiolipoma in a 10-year-old female. She presented with vague symptoms like dizziness without neurological deficits and radiological evaluation confirmed a left-sided infratentorial cisternal partially enhancing mass. She underwent craniotomy and had complete resection of the mass, which was histologically composed of mature adipocytes and blood vessels, consistent with angiolipoma. A review of the literature found only 18 cases of intracranial angiolipoma ever reported with our case representing the first case of infratentorial cisternal region.

Cellular angiolipoma: a case report and review of the literature.

Cellular angiolipoma is a rare subtype of angiolipoma, with vascular density approaching 95%. This case report describes a 55-year-old female that presented for treatment of a mass in her left breast that had been tender to slightly painful on palpation for nearly 2 years The patient underwent surgical excision of the mass, which was pathologically confirmed as a cellular angiolipoma. As of the 3-year follow-up, the patient reported no recurrence of the lesion. It is important to report this case and refresh knowledge of this and similar lesions to raise awareness of this diagnosis and treatment and improve future management of cellular angiolipoma cases.

A Case of Thoracic Epidural Angiolipoma Causing Severe Spinal Cord Compression With Neurologic Manifestations.

A spinal epidural angiolipoma is a rare, benign tumor of adipocytes and blood vessels that accounts only for a small percentage of all spinal axis tumors. We report a case of a 44-year-old male who presented with three months of progressive decreased sensation and strength from about six cm above the umbilicus down to his feet bilaterally. He presented to the emergency room when he could no longer walk. He also had neurogenic urinary retention and likely neurogenic constipation. Physical exam was notable for decreased sensation, decreased strength, and increased patellar reflexes bilaterally. MRI of the thoracic spine showed a posterior epidural mass that spanned from T2 to T3, measuring 1.2 x 1.7 x 4.3 cm, and severely compressed the spinal cord posteriorly. The patient underwent an urgent laminectomy for decompression and mass resection. Pathology was consistent with an angiolipoma. Postoperatively, he experienced a drastic improvement in strength and gross motor skills. The sensation had a partial return following surgery and continued to improve over the hospital stay. In general, the literature reports significant symptomatic improvement in patients with spinal epidural angiolipomas after surgical resection.

Intraoral approach for the treatment of non­infiltrating angiolipoma of the floor of the mouth in an elderly patient: A case report with review of the literature.

A 75-year-old male patient visited Gangneung-Wonju National University Dental Hospital (Gangneung, South Korea) with a 35-mm fluctuant lesion on the floor of the mouth. It was a dome-shaped exophytic lesion with its top on Wharton's duct orifice area. The encapsulated lesion was excised cautiously and the final diagnosis was non-infiltrating angiolipoma. To the best of our knowledge, this is the first report of an intraoral approach for the treatment of a non-infiltrating angiolipoma on the floor of the mouth in an elderly patient. Differentiating it from a ranula is essential for the surgical approach and, as there is a higher transition to infiltrating angiolipoma, definite treatment should be considered in elderly patients.

[Esophageal Angiolipoma:Report of One Case and Literature Review].

Esophageal angiolipoma is a rare disease with unspecific clinical manifestations.This paper reported a case of esophageal angiolipoma confirmed by upper gastrointestinal endoscopy and summarized the clinical manifestations,endoscopic and pathological features,treatment and prognosis of the patients by reviewing the relevant literature,aiming to provide references for clinical diagnosis and treatment of this disease in the future.

Intraosseous angiolipoma of the humerus: a second case report.

To document a case of an intraosseous angiolipoma (IOAL) of the humerus. Case presentation: A 52-year-old woman presented with gradually increasing pain in her right arm. A X-ray series of the right elbow and computed tomography revealed a nonexpanding radiolucent lesion in the distal end of the right humerus. The fatty nature of the lesion was further verified using fat-suppression techniques on magnetic resonance imaging sequences. Clinical discussion: The tumor was surgically excised, and the patient has experienced no symptoms for 2 years now. Histopathological findings confirmed the presence of an IOAL, which is an extremely rare intraosseous tumor that consists of thin blood vessels and mature adipose tissue. Conclusion: Accurate diagnosis of an IOAL is challenging; therefore, careful planning and assessment are paramount in the management of such lesions, with histological findings being essential for a conclusive diagnosis and surgery is the most suitable treatment choice in most cases.

Angiolipoma of the Lower Lip: A Rare Case Report.

Angiolipoma is a benign soft tissue tumor composed of mature adipocytes and small capillaries. Although it can occur in any part of the body, it is rare in the oral cavity, especially in the lips. We report the case of a 47-year-old male who presented with a painless, slow-growing mass on the right lower lip that had gradually increased in size over several months. The initial diagnosis included lipoma, mucocele, and hemangioma. The mass was surgically excised, and the histological examination confirmed the diagnosis of angiolipoma. Angiolipomas involving the lips are rare and can be easily misdiagnosed. Therefore, clinical suspicion, along with appropriate imaging and histological examination, is essential for an accurate diagnosis and appropriate management. The patient had a smooth recovery after surgery and showed no recurrence of the condition during the one-year follow-up examination.

Post-partum paraplegia following spinal anaesthesia: a report of two rare cases.

Pregnancy and lumbar puncture are rare instances that can precipitate sudden onset paraplegia in patients with otherwise slow-growing intradural tumours. Surgeons and anaesthesiologists should be aware of the etiological factors leading to pregnancy- and delivery-related rapid tumour growth and its complications. Lumbar puncture-related complications leading to acute precipitation of neurological symptoms must be addressed promptly for favourable outcome in such patients. We describe the report of two patients who developed acute onset paraparesis after spinal anaesthesia for caesarean section. Both were found to be having undiagnosed spinal tumours and managed surgically. We recommend urgent MRI in cases of acute onset non-resolving paraparesis in the peripartum period, for timely diagnosis and management of this rare clinical entity.

CT and MRI presentation of intradural epidural angiolipoma of the thoracic spinal canal (with a case report).

Epidural angiolipoma is a rare benign tumor consisting of mature adipocytes, blood sinuses, capillaries, and small blood vessels. It constitutes about 0.04%-1.2% of spinal axis tumors and about 2%-3% of extradural spinal tumors. We report a case of thoracic epidural angiolipoma and review the literature. We describe a 42-year-old woman who had weakness and numbness in her lower extremities prior to diagnosis and had an onset of approximately 10 months. The patient was misdiagnosed as schwannoma on preoperative imaging, possibly because neurogenous tumor is the most common intramedullary subdural tumor, and the lesion grew into bilateral intervertebral foramina. However, the lesion demonstrated high signal on the T2-weighted and T2 fat suppression sequences, and the linear low signal at the lesion edge was ignored, leading to misdiagnosis. The patient underwent posterior thoracic 4-6 laminectomy, pathectomy, and spinal decompression/vertebroplasty under general anesthesia. The final pathologic diagnosis was intradural epidural angiolipoma of the thoracic vertebra. Spinal epidural angiolipoma is a rare benign tumor that occurs frequently in middle-aged women and is mostly located on the dorsal side of the thoracic spinal canal. Magnetic resonance imaging findings of spinal epidural angiolipoma depend on the ratio of fat to blood vessels. Most angiolipomas show equal or high signal on T1-weighted images and high intensity on T2-weighted images, with significant enhancement after injection of gadolinium. The treatment of spinal epidural angiolipoma is complete surgical resection with good prognosis.

Laparoscopic approach in the treatment of splenic angiolipomatous hamartoma: the first report of a case.

Angiolipomatous hamartoma is a benign mesenchymal proliferation of unknown aetiology. Only a few cases have been documented in the published literature. This current case report describes a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment. The patient had been surgically treated 10 years previously; a lobectomy of the superior left pulmonary lobe had been performed in order to remove a verified tumour lesion. A complete radiological examination was undertaken, which verified a spleen of a size that was within the physiological range, with a centrally-located lobular tumour lesion. Given the risk of splenic rupture, as well as the fact that the lesion's aetiology was still undetermined, and finally the fact that differential diagnostics indicated the possibility of a metastasis, the patient was treated surgically. Laparoscopic splenectomy, in the treatment of splenic diseases, even rare ones such as this, is not a novelty. Indeed, it needs to be applied as the standard approach, with the well-known benefits that the minimalized approach offers.

Angiolipoma: a review of 778 lesions in 344 patients.

BACKGROUND: Angiolipomas are benign subcutaneous nodules that are commonly multifocal and easily overlooked by those not familiar with their appearance. The objective of this study was to identify the spectrum of the clinical and imaging features of this lesion, to include MR, CT, and US features. METHODS: A retrospective review of our institutional pathology database for biopsy-proven cases of angiolipoma between January 1, 2019, through December 31, 2021, was done. We identified 334 patients who underwent surgical resection of 788 individual lesions. MR imaging studies were available in 43 cases, CT in 39 cases, and ultrasound imaging in 72 cases. Clinical features (patient age, gender, surgical indication, number of lesions) were reviewed. Imaging feature analysis included the anatomic location, content of fat, vascularity, and modality-specific imaging features. RESULTS: All 778 angiolipomas were located in the subcutaneous tissues (median size, 2.4 cm, range 0.4-7.7 cm), with over 51% located in the upper extremity. The most common presentation was a symptomatic mass or slowly growing symptomatic mass. Imaging showed a subcutaneous lesion with a lobulated bean shape, which typically abutted the skin. Intralesional fat was identified in 85% of lesions on CT and MRI. Vessels were commonly seen on CT and MR, with enhancement best seen on MR. On US, lesions were heterogeneous and mildly hyperechoic, most often with no identifiable vascularity. CONCLUSION: Angiolipomas typically have characteristic imaging features. Awareness of this diagnosis and the spectrum of its imaging features is important and can facilitate a definitive diagnosis.

Intraosseous angiolipoma of the mandible.

INTRODUCTION: The angiolipoma is an uncommon histologic variant of lipomas, accounts for 5-17% of lipomas. Intraosseous lipomas of the jaws are extremely rare. The aim of the present article is to report and discuss another case of intramandibular angiolipoma. CASE REPORT: A 66-year-old man was referred to the Dentistry Department for the diagnosis and treatment of a lesion in the mandible. Past medical history included HIV positivity. The patient was asymptomatic. A CT scan revealed the incidental finding of a well-defined radiolucent image in the right body of the mandible, in the edentulous first molar / second premolar region, with sclerotic margins, and in contact with the mandibular canal, that was preserved. A conservative enucleation under local anesthesia was decided, together with the patient. Histopathological findings were consistent with the diagnosis of angiolipoma. DISCUSSION: Clinically, most intraosseous lipomas are asymptomatic, including the present case. Histological findings are essential for the diagnosis of intraosseous angiolipoma: mature neoplastic adipocytes streaked with numerous interspersed vascular spaces / blood vessels surrounded by mast cells and filled with red cells and several fibrous microthrombi are characteristics of angiolipomas. CONCLUSIONS: The diagnosis of intraosseous angiolipomas of the jaws may be difficult due to their rarity and it requires a histopathological examination.

Case Report: Giant Thyroid Angiolipoma-Challenging Clinical Diagnosis and Novel Genetic Alterations.

BACKGROUND: A 64-year-old man presented with a 7.8 cm lipomatous thyroid mass discovered on magnetic resonance imaging. METHODS: After two non-diagnostic fine needle aspirations (FNAs) were performed, computed tomography (CT) revealed features concerning for malignancy including central necrosis and infiltrative borders. A third FNA was still non-diagnostic. Total thyroidectomy was performed. RESULTS: Upon pathologic examination, the final diagnosis was primary thyroid angiolipoma. The lesion contained central fat necrosis with ischemic features, attributable to the FNAs. CONCLUSION: Ours is the third published case report of this rare entity. To date, no lipomatous thyroid tumor has undergone extensive genomic testing. Next-generation sequencing of our case revealed multiple genetic alterations, supporting the concept of angiolipomas being true neoplasms. Whereas the two previously reported cases in the literature were radiographically much smaller and appeared indolent, the large tumor in our case exhibited radiographic features concerning for liposarcoma, which belied the benign final pathologic diagnosis. Our case demonstrates that conservative surgical management (partial thyroidectomy) may be considered for lipomatous thyroid tumors, with further interventions to be determined only after final pathologic diagnosis.