Chronic Low Back Pain in a Prostate Cancer Survivor with Multiple Lipomas and Epidural Lipomatosis: A Case Report
Paulina Giacomelli, David Ho, Shahira Khoury
Department of Physical Medicine and Rehabilitation; University of California, Irvine
Background:
•Spinal epidural lipomatosis (SEL) involves abnormal fat accumulation in the epidural space and is often linked to chronic steroid use, obesity, and endocrine disorders (1,2).
•It can cause neurological symptoms such as myelopathy, cauda equina syndrome, and chronic back pain.
•Long-term steroid and hormone therapies are associated with SEL and subcutaneous lipomas, especially in patients with malignancies like prostate cancer (3,4).
•However, cases documenting both SEL and subcutaneous lipomas are rare, particularly in the context of prostate cancer treatment.
Purpose:
•The purpose of this case report is to highlight SEL as a potential complication from long-term steroid and hormone therapy, with consideration that when possible, cessation of treatment could alleviate radiculopathic symptoms and limit lipoma growth.
Case Description:
•Presentation: A 78-year-old male with a history of high-risk localized prostate adenocarcinoma, managed with leuprolide, abiraterone, and long-term prednisone for two years, presented with chronic low back pain and radiculopathic symptoms. Concurrently, the patient developed multiple subcutaneous lipomas on his torso, back, and upper limbs.
•Imaging: MRI revealed multilevel degenerative changes, severe spinal stenosis, and dorsal epidural lipomatosis, without evidence of metastatic disease (Image 1). Ultrasound revealed multiple lipomas (Image 2).
•Treatment: Given the development of diffuse subcutaneous lipomas, cessation of steroids was initiated.
•Results: Three months thereafter, the radiculopathic symptoms resolved. However, the diffuse subcutaneous lipomas continued to enlarge and became increasingly painful, leading to multiple surgical excisions which provided significant pain relief post-procedurally.
Discussion:
•This case highlights the interplay between chronic steroid and hormone therapy and the development of lipomas, both subcutaneous and epidural.
•The patient’s radiculopathic symptoms, initially attributed to degenerative spine disease, resolved after the cessation of prednisone, suggesting a relationship between steroid therapy and the size of epidural lipomatosis.
•Long-term corticosteroid therapy has been well-documented to induce adipose tissue hypertrophy, leading to conditions such as SEL and subcutaneous lipomas. However, the concurrent presentation of these conditions in a single patient with prostate cancer is uncommon.
•Comprehensive evaluation and multidisciplinary management of chronic low back pain in cancer survivors is crucial when considering rare but significant complications such as SEL and symptomatic subcutaneous lipomas.
Conclusion:
•Managing chronic low back pain in prostate cancer survivors with concurrent SEL and multiple subcutaneous lipomas is challenging.
•The rarity of these cases highlights the need for thorough evaluation, awareness of complications from long-term steroid and hormone therapy, and tailored management strategies to optimize patient outcomes.
References:
1. Walker PB, Sark C, Brennan G, Smith T, Sherman WF, Kaye AD. Spinal Epidural Lipomatosis: A Comprehensive Review. Orthop Rev (Pavia). 2021 Jul 11;13(2):25571. doi: 10.52965/001c.25571.
2. Roy-Camille R, Mazel C, Husson JL, Saillant G. Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases. Spine (Phila Pa 1976). 1991 Dec;16(12):1365-71. doi: 10.1097/00007632-199112000-00004.
3. Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J. 2019 Sep;9(6):658-665. doi: 10.1177/2192568218793617. Epub 2018 Aug 13. PMID: 31448201; PMCID: PMC6693071.
4. Mallard F, Buni M, Nolet PS, Emary P, Taylor JA, Moammer G. Lumbar spinal epidural lipomatosis: A case report and review of the literature. Int J Surg Case Rep. 2021 Jan;78:71-75. doi:10.1016/j.ijscr.2020.11.128. Epub 2020 Nov 30. PMID: 33310475; PMCID: PMC7736757.
5. Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005 Mar-Apr;5(2):202-11. doi:10.1016/j.spinee.2004.05.252. PMID: 15795966.
