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Morning Meeting

Morning Meeting. Date: 2011/12/08 Present by: 甘錦康 Supervisor: VS 李宜堅. Case 1. Information. 63 year-old female Past History HTN with mx control. Chief Complaints: left leg pain and numbness for 1 month. Brief history. Left leg pain & numbness x 1 month. Dr. Lee OPD.

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Morning Meeting

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  1. Morning Meeting Date: 2011/12/08 Present by: 甘錦康 Supervisor: VS 李宜堅

  2. Case 1

  3. Information 63 year-old female Past History HTN with mx control • Chief Complaints: • left leg pain and numbness for 1 month

  4. Brief history Left leg pain & numbness x 1 month Dr. Lee OPD

  5. Physical Examination: No specific finding Neurological Examination: Muscle power Deep Tendon Reflex

  6. Brief history Left leg pain & numbness x 1 month Dr. Lee OPD MRI: T9 -11 epidural spinal tumor + cord compression L4/5 HIVD Admission for operation

  7. Image T2 T1 Gadolinium T9 L1

  8. Problem List & plan T9-11 epidural spinal tumor Arrange laminectomy and tumor excision

  9. 11/08 T9-11 laminectomy and epidural tumor grossly total excision

  10. Hospitalization course 11/08 T9-11 laminectomy and epidural tumor grossly total excision Reheab. Left leg numbness and weakness Bedside PT 11/10 Stand up  11/15 Discharge PATHOLOGICAL DIAGNOSIS: Lipovasculartissue, compatible with angiolipoma

  11. Case 2

  12. Information A 40 year-old female/ • Chief Complaints: • Left lateral thigh pain for 2 months

  13. Brief history Left thigh pain since 2~3 months ago => aggravated when she got up from or changed position in bed LMD Physical therapy Partially relieved KGH

  14. Neurological Examination Muscle power Deep Tendon Reflex

  15. Brief history Left thigh pain since 2~3 months ago => aggravated when she got up from or changed position in bed LMD Physical therapy Partially relieved KGH MRI: Spinal tumor at L2~L3 levelwith spinal cord compression Dr. Lee OPD Admission for operation

  16. T2 T1 Gadolinium L1

  17. 11/12 L1~L3 Laminectomy with grossly total tumor removal

  18. Hospitalization course 11/12 L1~L3 Laminectomy with grossly total tumor removal Lower extremities weakness or numbness x Mild low back pain  11/19 Discharge PATHOLOGICAL DIAGNOSIS: Angiolipoma

  19. Spinal Angiolipoma

  20. Angiolipoma Rare, benign mesenchymal tumors In 2002 76 case s had histologically confirmed 72 cases were extradural & 4 cases intramedullary Containing mature adipose tissue + abnormal vascular elements Uptodate online edition

  21. Angiolipoma • Liebscher: first described in 1901 • Spinal angiolipomas : 0.14-1.2% of all spinal axis tumors • Approximately 2-3% of extradural spinal tumors Australasian Radiology (2002) 46, 84–90

  22. Angiolipoma Lin & Lin Subdivide into 2 types; noninfiltrating & infiltrating Infiltrating -lesions primarily involve the spine More common in women (noninfiltrating) infiltrating type isseen equally in male and female patients Most commonly diagnosed during the 5th decade The Spine Journal 7 (2007) 739–744 The Spine Journal 7 (2007) 739–744 Uptodate online edition

  23. Angiolipoma Most occur in the spinal canal usually in the thoracic level (mid-thoracic spine) almost all are epidural Intradural lesion have a relatively brief clinical course Intraduralv.s extradural: 5.8 vs 25.8 months Uptodate online edition

  24. Angiolipoma Arise from the posterior epidural space at the thoracic levelsand usually extend over three to four vertebral bodies Spinal cord compression & back pain is a frequent initial symptoms The Spine Journal 7 (2007) 739–744 Uptodate online edition

  25. Predisposing factors Weight gain in pregnancy was observed to increase the risk of spinal angiolipoma Obesity is occasionally reported in patients with spinal angiolipoma The Journal of Spinal Cord Medicine Volume 31 Number 3 2008

  26. MRI features The MRI differential diagnosis for an intraspinalhyperintense mass on a T1-weighted image includes lipoma, lipomatosis, angiolipoma, myelolipoma, subacutehaematoma, dermoidcyst and melanoma Australasian Radiology (2002) 46, 84–90

  27. MRI features Complete suppression of high signal intensity on fat-suppressed T1-weighted images exclude melanin or methaemoglobin Contrast enhancement exclude lipoma and lipomatosis Australasian Radiology (2002) 46, 84–90

  28. MRI features Complete suppression of high signal intensity on fat-suppressed T1-weighted images exclude melanin or methaemoglobin Contrast enhancement exclude lipoma and lipomatosis The combination of suppression of fat signal and contrast enhancement is the hallmark of angiolipoma Australasian Radiology (2002) 46, 84–90

  29. Take home message Benign mature adipose tissue with abnormal vascular MRI diagnosis: T1: hyperintense Fat-suppressed: high signal intensity Contrast: enhancement Operation: Released spinal cord to prevent nerve injury Sample for diagnosis

  30. Thank You For Your Attention!

  31. Quiz 1 • Hallmarks of Spinal Angiolipoma? • Occurrence in middle-aged • Often female patients • Always localization of thoracic spine • Almost intradural

  32. Quiz 1 • MRI features of Spinal Angiolipoma , except? • T1: hyperintense • Fat-suppressed: high signal intensity • Contrast: enhancement • All of above

  33. Which diagnosis is not favor? Lipoma Angiolipoma Myelolipoma Meningioma

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