The "Eagle Ray Sign" of the Lumbar Epidural Space: A Case of Vascular-Dominant Spinal Angiolipoma Mimicking Aetobatus spp. Morphology with Favorable Outcome and Literature Review.

Spinal epidural angiolipomas (SEALs) are rare, benign mesenchymal tumors composed of mature adipocytes and anomalous vascular channels, representing only 0.04–1.2% of all spinal tumors. This study presents a rare case of a lumbar SEAL and proposes the "Eagle Ray Sign" as a morphological descriptor to characterize its unique macroscopic appearance during surgical resection. A 32-year-old woman presented with a history of insidious, progressive, and mechanically induced low back pain. Diagnostic evaluation included lumbar CT, MRI, and spinal cord angiography. Total surgical resection was performed via a bilateral L2-L3 laminectomy, followed by definitive histopathological analysis. MRI revealed a posterior epidural mass with T1 hyposignal and T2 hypersignal, showing marked homogeneous enhancement. Preoperative angiography demonstrated no tumor blush, suggesting a discrepancy between MRI enhancement and actual vascularity. Intraoperatively, the resected en bloc specimen exhibited a distinctive morphology resembling a duckbill eagle ray (Aetobatus spp.). Histology confirmed a benign proliferation of mature adipocytes and dilated capillary structures. Postoperatively, the patient achieved complete resolution of symptoms. While SEALs typically favor the thoracic region, they should be considered in the differential diagnosis of lumbar compressive lesions. The proposed "Eagle Ray Sign" serves as a memorable macroscopic descriptor rather than a preoperative diagnostic tool. Gross-total surgical excision remains the definitive treatment, offering an excellent functional prognosis and high rates of long-term remission. • Report of a rare lumbar spinal epidural angiolipoma in a 32-year-old female. • Introduces the "Eagle Ray Sign" to describe the unique tumor macroscopic morphology. • Details a diagnostic discrepancy between intense MRI enhancement and negative angiography. • Successful total en bloc resection achieved via a bilateral L2-L3 laminectomy. • Complete pain resolution and full return to professional activities within 3 months.