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Radiofrequency ablation of a rare pathology: vertebral intraosseous lipoma
ARTICLE IN PRESS
The Spine Journal ■■ (2015) ■■–■■
Images of Spine Care Radiofrequency ablation of a rare pathology: vertebral intraosseous lipoma A 27-year-old man presented to the neurosurgery clinic with back pain localized on the left costovertebral angle. He had no history of trauma. On physical examination there was mild thoracic spine tenderness. No abnormal laboratory finding was found.After plain radiograph, a computed tomography scan was performed, which revealed an expansile mass with fat density in the left pedicle of the T12 vertebra (Figure Left). A computed tomography-guided biopsy was performed, and the lesion was confirmed to be an intraosseous lipoma pathologically. In another session it was treated successfully with radiofrequency ablation under general anesthesia (Figure Middle and Right). Intraosseous lipoma is a rare bone tumor that proliferates from mature lipocytes and usually involves the lower extremities [1]. Because malignant transformation rate of intraosseous lipoma is quite low, some authors have suggested follow-up for asymptomatic patients instead of invasive treatment [2]. Curettage and bone grafting is the treatment of choice in symptomatic cases. Radiofrequency ablation, a minimally invasive procedure that requires shorter hospitalization and has lower complication rates compared with surgery, may be another reasonable option for the treatment of this lesion. Further studies are needed for the confirmation of this conclusion.
References [1] Unni KK. Lipoma and liposarcoma. Dahlin’s bone tumors. General aspect and data on 10165 cases. Philadelphia, PA: Lippincott-Raven; 2010. p. 298–302. [2] Campbell RS, Grainger AJ, Mangham DC, Beggs I, Teh J, Davies AM. Intraosseous lipoma: report of 35 new cases and a review of the literature. Skeletal Radiol 2003;32:209–22.
Orhan Özbek, MDa Fatih Keskin, MDb Hasan Emin Kaya, MDa I˙brahim Güler, MDc Alaaddin Nayman, MDc Osman Koç, MDa a Meram School of Medicine, Department of Radiology Necmettin Erbakan University Beys¸ehir Street, Konya 42080, Turkey b Meram School of Medicine, Department of Neurosurgery Necmettin Erbakan University Beys¸ehir Street, Konya 42080, Turkey c Selçuk School of Medicine, Department of Radiology Selçuk University Alaeddin Keykubat Campus, Selçuklu, Konya 42080, Turkey
FDA device/drug status: Not applicable. Author disclosures: OÖ: Nothing to disclose. FK: Nothing to disclose. HEK: Nothing to disclose. I˙G: Nothing to disclose. AN: Nothing to disclose. OK: Nothing to disclose.
Figure. (Left) A hypodense lesion with fat density in the left pedicle of the T12 vertebra is seen on CT. (Middle) Radiofrequency ablation of the lesion using a coaxial system. (Right) On T1-weighted image obtained 3 months later, the lesion is hypointense because of extensive fat necrosis. http://dx.doi.org/10.1016/j.spinee.2015.09.058 1529-9430/© 2015 Elsevier Inc. All rights reserved.
The Spine Journal ■■ (2015) ■■–■■
Images of Spine Care Radiofrequency ablation of a rare pathology: vertebral intraosseous lipoma A 27-year-old man presented to the neurosurgery clinic with back pain localized on the left costovertebral angle. He had no history of trauma. On physical examination there was mild thoracic spine tenderness. No abnormal laboratory finding was found.After plain radiograph, a computed tomography scan was performed, which revealed an expansile mass with fat density in the left pedicle of the T12 vertebra (Figure Left). A computed tomography-guided biopsy was performed, and the lesion was confirmed to be an intraosseous lipoma pathologically. In another session it was treated successfully with radiofrequency ablation under general anesthesia (Figure Middle and Right). Intraosseous lipoma is a rare bone tumor that proliferates from mature lipocytes and usually involves the lower extremities [1]. Because malignant transformation rate of intraosseous lipoma is quite low, some authors have suggested follow-up for asymptomatic patients instead of invasive treatment [2]. Curettage and bone grafting is the treatment of choice in symptomatic cases. Radiofrequency ablation, a minimally invasive procedure that requires shorter hospitalization and has lower complication rates compared with surgery, may be another reasonable option for the treatment of this lesion. Further studies are needed for the confirmation of this conclusion.
References [1] Unni KK. Lipoma and liposarcoma. Dahlin’s bone tumors. General aspect and data on 10165 cases. Philadelphia, PA: Lippincott-Raven; 2010. p. 298–302. [2] Campbell RS, Grainger AJ, Mangham DC, Beggs I, Teh J, Davies AM. Intraosseous lipoma: report of 35 new cases and a review of the literature. Skeletal Radiol 2003;32:209–22.
Orhan Özbek, MDa Fatih Keskin, MDb Hasan Emin Kaya, MDa I˙brahim Güler, MDc Alaaddin Nayman, MDc Osman Koç, MDa a Meram School of Medicine, Department of Radiology Necmettin Erbakan University Beys¸ehir Street, Konya 42080, Turkey b Meram School of Medicine, Department of Neurosurgery Necmettin Erbakan University Beys¸ehir Street, Konya 42080, Turkey c Selçuk School of Medicine, Department of Radiology Selçuk University Alaeddin Keykubat Campus, Selçuklu, Konya 42080, Turkey
FDA device/drug status: Not applicable. Author disclosures: OÖ: Nothing to disclose. FK: Nothing to disclose. HEK: Nothing to disclose. I˙G: Nothing to disclose. AN: Nothing to disclose. OK: Nothing to disclose.
Figure. (Left) A hypodense lesion with fat density in the left pedicle of the T12 vertebra is seen on CT. (Middle) Radiofrequency ablation of the lesion using a coaxial system. (Right) On T1-weighted image obtained 3 months later, the lesion is hypointense because of extensive fat necrosis. http://dx.doi.org/10.1016/j.spinee.2015.09.058 1529-9430/© 2015 Elsevier Inc. All rights reserved.