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Título

Late diagnosis of spinal cord lipoma: a case-based update

RESUMO

CASE PRESENTATION: A 20-year-old woman is admitted with progressive paraparesis started two months ago. Magnetic Resonance Imaging (MRI) showed an expansive intradural lesion, with thoracic spinal compression (T7-T8), hyperintense in T1/T2 and hypointense in T2 with fat saturation (T2 FAT). In an axial view, the spinal canal was affected in >75% of its area. Biopsy revealed sections of mesenchymal neoplasia composed of mature adipose cells, confirming the diagnosis of myelolipoma. In the surgical procedure, partial resection was performed due to the wide adherence of nervous structures, with significant spinal decompression. There was complete neurological improvement, without post-surgical complications.
DISCUSSION: Non-dysraphic spinal cord lipomas compound less than 1% of spinal cord lesions. The diagnosis is usually made in children, without sex predilection. In this work, is presented a late diagnosis case of spinal cord lipoma. Clinical, imaging and surgical discussions are also done. Myelolipoma is a rare non-dysraphic spinal cord tumor, infrequently diagnosed in adults. The most accepted hypothesis of its origin determines an association with defects in neurulation during embryogenesis. Intramedullary lipoma patients usually present neurological deficits secondary to mass effect, having a subtle clinical presentation, slowly progressive myelopathy and a rapid neurological dysfunction after a long period of indolent tumor growth. The clinical manifestations include pain, paraparesis and paraesthesias, varying according to the lesion location and size, commonly the cervical-thoracic region. MRI is the most sensitive exam for diagnosis, with hyperintense lesions in T1 being characteristics of lipomas, confirmed by sequences with suppression of the fat signal. Treatment ranges from conservative methods, such as diet therapy, to aggressive surgical remove of the tumor. The main objective of surgery is to decompress adjacent structures, since lipomas cannot be completely resected. The prognosis of surgically treated patients is satisfactory, including pain reduction and neurological improvement. Tumor remissions have not been reported.
FINAL COMMENTS: Although rare, especially in adults, spinal cord lipomas must be known, as these tumors are well detected on MRI, their surgical approach is effective and, if left untreated, they evolve with sudden neurological worsening.

Palavras Chave

spinal cord lipoma, neurosurgery, paraparesis