Extradural Lumbar Spinal Angiolipoma: A Case Report and Review of Literature on Rare Benign Tumors

Spinal angiolipomas (SALs) are rare benign tumors composed of mature adipose tissue interspersed with abnormal vascular channels. Their occurrence in the lumbar region is particularly exceptional, with fewer than 20 cases reported in the literature. The clinical presentation is often nonspecific and typically reflects chronic spinal cord or nerve root compression, which can lead to delayed diagnosis. We report the case of a 58-year-old woman who presented with progressive lower back pain persisting for 18 months and initially attributed to musculoskeletal causes. Magnetic resonance imaging (MRI) revealed a well-circumscribed lesion at the L4 level showing both fatty and vascular components, while computed tomography confirmed the absence of calcification or bone erosion. The patient underwent complete resection through hemilaminectomy, which achieved total removal of the lesion. Histopathological examination demonstrated a nonencapsulated angiolipoma without malignant features. Postoperative recovery was uneventful, with resolution of symptoms and no evidence of recurrence on follow-up. This case highlights the diagnostic challenges posed by lumbar SALs, emphasizes the pivotal role of MRI in differentiating them from other epidural masses, and underlines the excellent prognosis achieved with surgical excision. Given their benign nature and lack of malignant potential, clinical awareness and accurate radiologic interpretation remain key to ensuring appropriate management when faced with unexplained chronic lumbar pain.