AB167. SOH25_AB_023. An unprecedented case: intraosseous angioleiomyoma in the 4th thoracic vertebra

Background: Angioleiomyoma is a rare benign soft tissue tumour predominantly found in the subcutaneous tissue of the lower limbs. Intraosseous angioleiomyoma is exceedingly rare and typically affects the appendicular or craniofacial skeleton. This case represents the first documented instance of intraosseous angioleiomyoma within a presacral vertebra.

Methods: A 42-year-old woman with new-onset back pain was treated empirically for psoriatic arthritis while awaiting routine imaging. She subsequently developed progressive lower limb sensorimotor deficits and presented to the hospital with moderate lower limb weakness and bilateral hyperreflexia. Multimodal imaging revealed intraosseous lesions at T4, with extradural extension (T2–5) causing displacement of the spinal cord.

Results: Multilevel decompressive laminectomy and tumour debulking were performed, with good patient outcome. Histology identified the lesion as angioleiomyoma, and the patient was monitored via surveillance imaging. Tumour progression was identified at 3 years post-operative, prompting readmission of the patient for posterior fixation and T4 corpectomy via open thoracotomy, with a similarly positive outcome.

Conclusions: This case underscores the clinical challenge posed by intraosseous angioleiomyoma within the vertebral column. Surgical treatment was complicated by location and tumour vascularity, with complete resection requiring both posterior and anterior approaches. Given the unprecedented recurrence of this patient’s intraosseous angioleiomyoma, long-term surveillance proved crucial to her care.

Keywords: Angioleiomyoma; cardiothoracic surgery; intraosseous angioleiomyoma; neurosurgical management; recurrence