Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2016; 22(43): 9654-9660
Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9654
Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu SY collected case data, prepared the photos and wrote the manuscript; Xie HY, Zhou L, Zheng SS and Wang WL proofread and revised the manuscript; all authors approved the final version to be published.
Supported by the National Basic Research Program (973 Program) in China, No. 2013CB531403; and the National Natural Science Foundation of China, No. 81572307.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital, School of Medicine, Zhejiang University.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: No commercial or associative interest in any form has been received or will be received from a commercial party related directly or indirectly to the subject of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Lin Wang, PhD, MD, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wam@zju.edu.cn
Telephone: +86-571-87236466 Fax: +86-571-87236466
Received: September 7, 2016
Peer-review started: September 8, 2016
First decision: September 28, 2016
Revised: October 10, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: November 21, 2016
Processing time: 72 Days and 13.9 Hours
Abstract

Myelolipoma is a rare tumor composed of fat and bone marrow components, most of which are located in the adrenal gland. Myelolipoma in the liver is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In one of these cases, the hepatic myelolipoma was found within a hepatocellular carcinoma (HCC). In the present study, we report the first case of the synchronous occurrence of hepatic myelolipoma and HCCs in different liver sections of one patient, a 26-year-old female who was admitted to our hospital because of a 4-d history of upper abdominal pain. The unenhanced computed tomography (CT) images showed a well-defined low-density mass with adipose components in the right liver lobe, 4.2 cm × 4.1 cm in size. Two inhomogeneous low-density masses were found in the left liver lobe, 8.6 cm × 7.7 cm and 2.6 cm × 2.6 cm in size. The masses in both the right and left liver lobes were heterogeneously enhanced in the contrast-enhanced CT images. Based on the results of the imaging examination, the mass in the right liver lobe was preliminarily considered to be a hamartoma, and the two masses in the left liver were preliminarily considered to be HCCs. We performed a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. Microscopic and immunohistochemical results revealed that the tumor in the right liver lobe was a hepatic myelolipoma, and that the two tumors in the left liver lobe were HCCs.

Keywords: Liver; Myelolipoma; Hepatocellular carcinoma; Hepatectomy; Hepatic lobectomy

Core tip: Hepatic myelolipoma is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In the present study, we report the first case of the synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas in different liver sections of one patient, who received a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. We also highlight the diagnosis and treatment of a hepatic myelolipoma and conduct a literature review to deepen the understanding of the subject.