Spinal Extradural Angiolipoma: A Report of Two Cases and Review of Literature

Spinal extradural angiolipomas (SEALs) are rare, benign neoplasms composed of mature adipocytes and vascular elements. They are often noninfiltrating and located in the posterior aspect of the spinal canal at the level of thoracic/dorsal vertebrae. Back pain, progressive paraparesis, and sensory disturbance in lower limbs are the typical symptoms. Here, we discuss two cases of SEALs presenting with subacute paraparesis. The magnetic resonance imaging of one patient was reported to be suggestive of spinal metastasis/plasmacytoma/sarcoma, while the other was reported as a spinal extradural hematoma. After laminectomy, both lesions were recognized as encapsulated extradural tumors and en-bloc resection was done. Postoperatively, the neurological deficits improved and there was no recurrence on 2-year follow-up. Histopathology characterized both of them to be extradural angiolipomas. Current experience and literature support curative surgical resection as the gold standard. The prognosis is excellent in most cases, even if total resection is not feasible. It is due to the slow-growing nature of the tumor and absence of malignant transformation.