TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background:    Angiolipomas are slow-growing, benign tumors originating from mesenchymal cells, characterized by mature adipocytes and delicate blood vessels. While most angiolipomas occur in subcutaneous tissues, intracranial lesions are exceedingly rare.

Case presentation:  We present the case of a 12-year-old female who presented with seizures, upward eye deviation, and slurred speech. MRI revealed a subpial heterogeneous signal conglomerate with adjacent chronic microhemorrhage in the right lateral sulcus along the superior temporal gyrus. A local reactive cortical atrophy with mild sulcal enlargement was noted, without significant mass effect. An abnormally hyperplastic cortical venous shunt, likely a cavernous angioma, was identified. Additionally, a single atrophic focus was observed in the left frontal lobe. Radiological findings classified the lesion as an "other specified congenital malformation of the circulatory system. She underwent craniotomy and excision of the mass, which, upon histological examination, comprised mature adipocytes and blood vessels, consistent with the diagnosis of intracranial angiolipoma.

Conclusions:       This case highlights the importance of including ICAL in the differential diagnosis of intracranial lipomatous tumors. MRI findings, coupled with histopathological confirmation, are essential for an accurate diagnosis. Surgical resection remains the preferred treatment, though complete removal may be challenging due to vascular involvement.

Pirotte B, Krischek B, Levivier M, Bolyn S, Brucher JM, Brotchi J. Diagnostic and microsurgical presentation of intracranial angiolipomas. Case report and review of the literature. J Neurosurg. 1998;88(1):129–32.

Bowen JT. Multiple subcutaneous hemangiomas, together with multiple lipomas, occurring in enormous numbers in an otherwise healthy, muscular subject. Am j med sci. 1912 aug;144(2):189–92.

Dixon AY, McGregon DH, Lee SH. Angiolipomas: an ultrastructural and clinicopathological study. Hum Pathol. 1981;12(8):739–47.

WR H, EB H. Angiolipoma. Arch Dermatol 1960;82(6):924–31.

McGregor DH, Kerley SW, McGregor MS. Case report: gastric angiolipoma with chronic hemorrhage and severe anemia. Am J Med Sci 1993; 305(4):229–35.

Kato K, Matsuda M, Onodera K, Sakata H, Kobayashi T, Kasai S. Angiolipoma of the colon with right lower quadrant abdominal pain. Dig Surg. 1999;16(5):441–4.

Lin JJ, Lin F. Two entities in angiolipoma(A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma). Cancer . 1974 Sep 34(3):720–7.

Omori T, Nakamura S. Angiolipoma of the chest wall: a case report. Surgical Case Reports 2022 8:1-4

Prabu SS, O’Donovan DG, Gurusinghe NT. Intracranial angiolipoma: report of two cases. Br J Neurosurg 1995; 9(6):793–8.

Weill A, del Carpio-O’Donovan R, Tampieri D, Melanson D, Ethier R. Spinal angiolipomas: CT and MR aspects. J Comput Assist Tomogr. 1991;15(1):83–5.

Lee SH, Bock MS, Sheen SH, Han I, Sohn S. Thoracic Spinal Angiolipoma: A Case Report and Literature Review. The Nerve. 2023 Oct 20;9(2):167–73.

Sharifi G, Mohammadi E, Bahranian A, Jafari A, Paraandavaji E, Akbari Dilmaghani N. Angiolipoma of the Central Nervous System Presenting with Bilateral Visual Loss; a Case Report and Review of Literature. Interdisciplinary Neurosurgery. 2023 Dec 1;34:101795.

Wilkins PR, Hoddinott C, Hourihan MD, Davies KG, Sebugwawo S, Weeks RD. Intracranial angiolipoma. J Neurol Neurosurg Psychiatry. 1987;50(8):1057–9.

Chen F, Pan Y, Teng Y, Pan X, Yu Y. Primary Intracranial Angioleiomyoma: A Case Report and Literature Review. World Neurosurg. 2020 Jun 1;138:145–52.

Morgan KM, Hanft S, Xiong Z. Cranial intraosseous angiolipoma: case report and literature review. Intractable Rare Dis Res. 2020 ;9(3):175–8.

Roncati L, Pusiol T, Piscioli F, Maiorana A. Subcutaneous cavernous angiolipoma: a new soft-tissue entity. Acta Dermatovenerol Croat. 2015;23(2):144–5.

Hornick JL. Practical Soft Tissue Pathology: A Diagnostic Approach A Volume in the Pattern Recognition Series. Practical Soft Tissue Pathology: A Diagnostic Approach A Volume in the Pattern Recognition Series. 2019 Jan ;1–584.

Ghosal N, Furtado S V., Saikiran NA, Gupta K, Hegde AS. Angiolipoma in sellar, suprasellar and parasellar region: report on two new cases and review of literature. Clin Neuropathol. 2011;30(3):118–21.