2008 Volume 22 Issue 2 Pages 221-225
A 56-year-old women noted numbness on the bottom of the left foot from about September, 2004, and experienced walking difficulty from January, 2005, and lumbago from February, 2005. She therefore underwent a neurological checkup at our hospital. Chest X-ray film showed a tumor shadow about 6 cm in diameter to the left of the mediastinum. Chest CT and MRI revealed a 50×35 mm left paravertebral hemisphere-shaped mass with extrapleural sign at the level of Th3-5. In addition, the tumor extended into the spinal canal through the T4-T5 intervertebral foramen, and the thoracic spinal cord was being compressed by it (Dumbbell type). Aortic angiogram showed dense vascularity and irregular tumor staining from the main feeder, the fourth intercostal artery. During the operation, the paravertebral part of the tumor was initially completely removed by open thoracotomy. When some feeding arteries were resected, the tumor shrank. Then, in the prone position, the intraspinal and foraminal tumor was removed through a Th3-5 laminectomy. Pathological examination demonstrated angiolipoma consisting of a combination of mature adipose tissue and multiple small blood vessels. After surgery, the patient's spastic palsy disappeared and she could walk normally 2 months postoperatively. There has been no sign of recurrence for two years following resection. Angiolipomas arising from the mediastinum are extremely rare; to our knowledge, only three cases have been reported, and all these cases were accompanied with extension into the spinal canal.
