An unusual thoracic spinal pathology presenting as a dorsally exophytic intramedullary lesion

Abstract

A 45-year-old woman presented with progressive spastic weakness of her lower limbs of 5 years' duration. She had previously undergone laminectomy and decompression of a thoracic lesion elsewhere. Magnetic resonance imaging of her spine (Fig. 1) demonstrated a well-defined intramedullary lesion from the T3 to T6 levels that was hyperintense on T1- and T2-weighted sequences. It had a broad, dorsally located exophytic component. Patchy areas of heterogeneously enhancing T2 isointense soft tissue components were seen in the superior aspect of the lesion (Fig. 2). There was no infiltration of the lesion into surrounding structures. The diagnosis was consistent with that of a recurrent intramedullary lipoma with a dorsally exophytic component. She underwent re-exploratory surgery and decompression of the lesion. Histopathology confirmed the lesion to be a lipoma. Fig. 2Gadolinium-enhanced T1 magnetic resonance imaging (MRI): (Left) midsagittal section showing patchy enhancement in the superior aspect of the lesion; (Right) axial section demonstrating the enhancing area extending into the exophytic component. View Large Image Figure Viewer Download Hi-res image