Thoracic epidural angiolipoma mimicking schwannoma: A case report and review of the literature

Background: Spinal angiolipoma is a rare benign epidural tumor composed of mature adipose tissue and vascular elements. Its radiological appearance may closely resemble that of a schwannoma, making preoperative diagnosis challenging. Case Description: A 74-year-old female presented with progressive gait disturbance. The thoracic magnetic resonance imaging (MRI) revealed a posterior epidural lesion at T2–T4 causing significant spinal cord compression; the initial diagnosis was schwannoma. However, when the patient’s neurological condition rapidly deteriorated (i.e., paraparesis with urinary incontinence), surgery revealed the histopathology to be consistent with a spinal angiolipoma. Conclusion: Thoracic spinal angiolipomas are rare benign tumors that may radiologically mimic a schwannoma. Although MRI is essential for lesion characterization and surgical planning, the diagnosis requires histopathological confirmation. Furthermore, immediate surgical resection in patients demonstrating the rapid onset of myelopathy/significant neurological deficits provides the best postoperative neurological outcomes.