A Case of Mistaken Identity: Spinal Epidural Angiolipoma
Bibliographic record
Abstract
Angiolipomas are benign neoplasms that appear as painful subcutaneous nodules in the forearm, trunk, or neck.Histopathologically, they are postulated to represent an intermediate entity in the spectrum between lipoma and hemangioma. 1 Angiolipomas rarely occur in the spinal cord and generally produce a slowly progressive myelopathy or radiculopathy from extrinsic spinal cord or nerve root compression. [2][3]3][4] We present the clinical, radiological, and histological characteristics of a patient with progressive myelopathy who subsequently underwent surgical resection of a dorsally located thoracic spinal epidural angiolipoma. CASE PRESENTATIONA 65-year-old overweight right-handed female with an unremarkable past medical history presented to our hospital with a nine-month history of bilateral, symmetrical, progressive numbness and burning in her feet, progressing cranially to the level of the umbilicus by the time of admission.Four months after the onset of her symptoms, the patient began having difficulties ambulating, with stiffness and weakness bilaterally in the lower extremities causing multiple falls.During hospitalization, she developed urinary hesitancy with no frank incontinence.Initial physical examination confirmed thoracic myelopathy, with mild symmetric paraparesis, hyperreflexia and upgoing plantar responses in the lower extremity.A sensory level for pinprick and vibration sense was noted at the T8 level.Computed tomography (CT) of the lumbar spine showed mild degenerative disc disease and an incidental left renal mass suspicious for malignancy.Subsequent magnetic resonance imaging (MRI) with midline cuts through the cervical and thoracic spine demonstrated an iso to hyperintense lesion compared to adjacent soft tissue at T5-7, causing significant compression of the spinal cord and a smaller T4/5 lesion with extension into the left neuroforamen (Figure 1).Both lesions were contrast enhancing.Based on the radiographic features and known prior left renal mass, the pre-operative diagnosis was metastasis versus lymphoma, with a low likelihood of a meningioma or peripheral nerve sheath tumor.The patient underwent posterior thoracic laminectomy T3-T7 for spinal cord decompression and resection of the epidural masses.Intraoperatively, the surgical site was hypervascular.Following the laminectomy, a large volume of soft, highly vascular, epidural fat was encountered, with the lesion embedded within.No tumor capsule could be identified.Scalloping of bone edges at T6 and increased vascularity of the adjacent bone was also noted, with some evidence of invasion of the lesion into the adjacent lamina.The lesion was completely resected en bloc by
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.013 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".