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Laparoscopic adrenalectomy for a giant adrenal myelolipoma: A case report. Int J Surg Case Rep 2021; 90:106678. [PMID: 34952312 PMCID: PMC8715075 DOI: 10.1016/j.ijscr.2021.106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
CASE PRESENTATION We describe a case of a patient who presented with a mildly symptomatic, giant myelolipoma which was excised by laparoscopic approach without complications. INTRODUCTION AND IMPORTANCE Adrenal myelolipoma (AML) is a rare tumour composed by fat and myeloid tissues. Usually it is asymptomatic, so the diagnosis is mostly incidental. It is generally located in the right adrenal gland, but it can also be found bilaterally. If its size exceeds 10 cm it is defined as a "giant myelolipoma"; in this case its treatment of choice would be adrenalectomy with an open surgical approach. CLINICAL DISCUSSION Patient's signs and symptoms were mild pain in the right hypochondrium and a positive right Giordano's sign. The mass was detected by a contrast-enhanced CT scan. Once excised it measured 16 cm. CONCLUSION Laparoscopic adrenalectomy for giant myelolipoma is a safe approach if performed by an expert surgeon, with low risk of bleeding and a better outcome for the patient.
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Kim DS, Lee JW, Lee SH. Spontaneous rupture of adrenal myelolipoma as a cause of acute flank pain: A case report. World J Clin Cases 2021; 9:6552-6556. [PMID: 34435025 PMCID: PMC8362562 DOI: 10.12998/wjcc.v9.i22.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adrenal myelolipoma is a rare, benign, non-functioning mass that occurs in the adrenal gland. It is composed of an admixture of hematopoietic elements and mature adipose tissue, similar to bone marrow. Even at large sizes, adrenal myelolipomas are usually asymptomatic and often incidentally found by ultrasonography or computed tomography (CT) scan. This paper describes an unusual case of adrenal myelolipoma presenting as flank pain.
CASE SUMMARY A 50-year-old male with severe right flank pain underwent a CT scan revealing a huge mass extending into the suprarenal space. The mass showed a fat component with retroperitoneal hemorrhage. The tumor was treated laparoscopically, and pathologic examination revealed features of myelolipoma originating from the adrenal gland.
CONCLUSION Adrenal myelolipomas are generally asymptomatic and can be treated conservatively. However, rupture and hemorrhage of the tumor can cause symptoms requiring surgical removal.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Jeong Woo Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
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Nakayama Y, Matayoshi N, Akiyama M, Sawatsubashi Y, Nagata J, Hisaoka M, Hirata K. Giant Adrenal Myelolipoma in a Patient without Endocrine Disorder: A Case Report and a Review of the Literature. Case Rep Surg 2018; 2018:4854368. [PMID: 29992078 PMCID: PMC6016169 DOI: 10.1155/2018/4854368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/23/2018] [Indexed: 12/24/2022] Open
Abstract
We herein present a surgically treated case of huge adrenal myelolipoma. A 62-year-old woman presented to our surgical outpatient clinic with a retroperitoneal tumor. A clinical examination revealed an elastic soft, smooth-surfaced, painless, child-head-sized tumor with poor mobility, which was located in the left upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed an uneven tumor surrounding the stomach, spleen, pancreas, and left kidney, which was 20 × 18 × 10 cm in size. The retroperitoneal tumor was resected. The tumor was attached to the surrounding organs, including the pancreas, spleen, and left kidney, but had not directly invaded these organs. The tumor was yellow and elastic soft and covered with a thin film. The origin of the tumor was suggested to be the left adrenal gland. The weight of the excised tumor was 1500 g. The histopathological diagnosis was adrenal myelolipoma. The patient had an uneventful recovery and was discharged from the hospital on the thirteenth day after the operation. She has been followed up in our outpatient clinic.
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Affiliation(s)
- Yoshifumi Nakayama
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan
| | - Nobutaka Matayoshi
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
| | - Masaki Akiyama
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan
| | - Yusuke Sawatsubashi
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan
| | - Jun Nagata
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
| | - Keiji Hirata
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan
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4
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Park SY, Kwak MK, Kim HJ, Park HK, Suh KI, Yoo MH, Jin SY, Yun S, Byun DW. Case report of a bilateral adrenal myelolipoma associated with Cushing disease. Medicine (Baltimore) 2017; 96:e9455. [PMID: 29384929 PMCID: PMC6392800 DOI: 10.1097/md.0000000000009455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Adrenal myelolipomas are rare benign tumors, composed of a variable mixture of mature adipose tissue and hematopoietic tissue. These tumors are frequently detected incidentally and are usually asymptomatic, and hormonally inactive. PATIENT CONCERNS During a routine health checkup, a 52-year-old man was found to have a tumor on the bilateral adrenal glands. Abdominal computed tomography revealed a well-defined, heterogeneously enhanced bilateral adrenal mass, suggesting a myelolipoma. DIAGNOSES The hormonal evaluation revealed adrenocorticotropic hormone (ACTH) dependent Cushing syndrome. INTERVENTIONS The patient underwent left adrenalectomy, and transsphenoidal resection of a pituitary mass. The final diagnosis was adrenal myelolipoma associated with Cushing disease. OUTCOMES Growth of right adrenal myelolipoma was detected during the 7-year follow-up. There were enhancing pituitary lesions in repeat magnetic resonance imaging of the sellar region, which implies persistent or recurrent pituitary adenoma. This case reinforces relationship between Cushing disease and adrenal myelolipoma. LESSONS To the best of our knowledge, this is the first reported pathologically confirmed bilateral adrenal myelolipoma associated with Cushing disease. This report supports the idea that ACTH is associated with the development of adrenal myelolipoma.
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Affiliation(s)
- Se Yoon Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Kyo-Il Suh
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Myung Hi Yoo
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - So Young Jin
- Departments of Pathology, Soon Chun Hyang University College of Medicine
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
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Shi Q, Pan S, Bao Y, Fan H, Diao Y. Primary mediastinal myelolipoma: a case report and literature review. J Thorac Dis 2017; 9:E219-E225. [PMID: 28449507 DOI: 10.21037/jtd.2017.02.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Myelolipoma is a kind of rare benign tumour composed of mature adipocytes and hemopoietic elements, and is most often found in the adrenal glands. Primary mediastinal myelolipoma (PMM) more rarely happens and has no definite symptoms, and mediastinal masses are usually found in chest examination. The patients normally receive a surgical resection and have a favorable prognosis after postoperative pathological diagnosis. Here, we present the case of PMM, which was resected via video-assisted thoracic surgery (VATS), and investigate recent correlative literatures to summarize its etiology, histopathology, differential diagnosis and therapeutic method. In this way, we aim to improve clinical doctors' understanding of this disease.
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Affiliation(s)
- Qingtong Shi
- Department of Cardiothoracic Surgery, The First People's Hospital of Yangzhou, Yangzhou 225000, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Shu Pan
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yang Bao
- Department of Cardiothoracic Surgery, The First People's Hospital of Yangzhou, Yangzhou 225000, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Huangxin Fan
- Department of Cardiothoracic Surgery, The First People's Hospital of Yangzhou, Yangzhou 225000, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Yali Diao
- Department of Cardiothoracic Surgery, The First People's Hospital of Yangzhou, Yangzhou 225000, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
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Himuro N, Minakata T, Oshima Y, Tomita Y, Kataoka D, Yamamoto S, Kadokura M. Video-assisted thoracic surgery for primary myelolipoma of the posterior mediastinum. J Cardiothorac Surg 2016; 11:1. [PMID: 26762224 PMCID: PMC4712462 DOI: 10.1186/s13019-016-0401-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/10/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myelolipoma is an uncommon tumor comprising adipose tissue and normal hematopoietic cells and mainly occurs in the adrenal cortex. Mediastinal myelolipoma is very rare; we report a case of posterior mediastinal myelolipoma that required surgical resection. CASE PRESENTATION A 56-year-old male was diagnosed with a posterior mediastinal tumor by computed tomography. The tumor was originally noted in 2005, and during follow-up in March 2014, it was found to have increased in size. During consultation at our hospital, on magnetic resonance imaging (MRI), we considered the possibility that the tumor was malignant. Consequently, we resected the tumor by video-assisted thoracic surgery (VATS). The histopathological findings revealed that the tumor had undergone intrathoracic extramedullary hematopoiesis. However, after considering the patient's background and histopathological findings, we diagnosed the tumor as a thoracic extra-adrenal myelolipoma. CONCLUSIONS Pathological analysis was instrumental in clarifying the diagnosis. We recommend surgery as a treatment option for posterior mediastinal tumors.
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Affiliation(s)
- Naoya Himuro
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan. .,Division of Chest Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Takao Minakata
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Yutaka Oshima
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Yuri Tomita
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Daisuke Kataoka
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Shigeru Yamamoto
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Mitsutaka Kadokura
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
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Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma. Case Rep Urol 2015; 2015:635072. [PMID: 26064766 PMCID: PMC4429215 DOI: 10.1155/2015/635072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b) with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma.
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8
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Park BH, Lee SL, Seo KJ, Bae SR, Lee YS, Kang SH, Han CH. Laparoscopic hand-assisted adrenal sparing surgery for a giant adrenal myelolipoma: A case report. Int Surg 2015; 102:469-472. [PMID: 25990775 DOI: 10.9738/intsurg-d-14-00289.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adrenal myelolipoma is a rare, benign tumor. Surgical resection is advocated in case of symptomatic, large size (> 4cm), increase of size on follow-up and atypical appearance on imaging. Laparoscopic adrenalectomy is currently the gold standard operation for managing benign adrenal mass. However, to date, laparoscopic entire resection of ipsilateral adrenal gland with the tumor have been mainly reported in the literature. Under clinical circumstances, adrenal sparing surgery underused as first-line therapy for adrenal tumors. CASE PRESENTATION We present a case of adrenal myelolipoma involving the right adrenal gland of a 45-year-old woman who presented with right-sided flank pain. On radiologic and endocrine evaluation, she was diagnosed with a giant adrenal myelolipoma (> 8cm). Right hand-assisted laparoscopic partial adrenalectomy was performed, and postoperative recovery was uneventful. Finally, histological examination confirmed adrenal myelolipoma. On follow-up computed tomography, there was no residual tumor and the remaining right adrenal gland. CONCLUSION Our report suggests that hand-assisted laparoscopic partial adrenalectomy could be considered for appropriate removal of adrenal myelolipoma, even in giant adrenal myelolipoma.
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Affiliation(s)
- Bong Hee Park
- a Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-Si, 480-717, Korea, Republic of
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9
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Zattoni D, Balzarotti R, Rosso R. The management of bilateral myelolipoma: Case report and review of the literature. Int J Surg Case Rep 2015; 12:31-6. [PMID: 25989259 PMCID: PMC4485682 DOI: 10.1016/j.ijscr.2015.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Bilateral adrenal myelolipoma is a rare benign neoplasm. We presented the case of a young man affected by a bilateral myelolipoma and the analysis of the literature of bilateral cases of myelolipoma. Our purpose is to give a suggestion of clear terms of reference regarding the management of this kind of bilateral neoplasm. PRESENTATION OF CASE We reported the case of a 41-year-old healthy man complained of abdominal pain in the upper quadrants. No significant alterations were found in routine blood and endocrinological tests. The imaging (CT and MRI) showed a huge right adrenal mass and a smaller lesion at the left adrenal gland. The preoperative pathological characterization was suggestive for a myelolipoma. A right open adrenalectomy was performed, and a radiological surveillance was planned for the left tumor. The pathological exam confirmed the diagnosis. DISCUSSION In literature, there are 36 cases described. The clinical presentation consisted of symptomatic tumors, incidentally diagnosed lesions or myelolipomas in patients with an associated endocrinal disorder. Symptomatic tumors or those bigger than 7cm, because of the potential risk of rupture, are usually treated surgically. In smaller (<7cm) and asymptomatic ones the surgical treatment is not univocal. CONCLUSION In the setting of the surgical treatment, it is important to preserve in some way the hormonal function. For that reason, the bilateral adrenalectomy has to be reserved for symptomatic or sizeable (>7cm) cases. As far as we know, this is the first review on bilateral myelolipomas.
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Affiliation(s)
- Davide Zattoni
- Department of General Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
| | - Ruben Balzarotti
- Department of General Surgery, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Raffaele Rosso
- Chief of Department of General Surgery, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
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10
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Kumar S, Jayant K, Prasad S, Agrawal S, Parma KM, Roat R, Kumar K. Rare adrenal gland emergencies: a case series of giant myelolipoma presenting with massive hemorrhage and abscess. Nephrourol Mon 2015; 7:e22671. [PMID: 25738127 PMCID: PMC4330691 DOI: 10.5812/numonthly.22671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Adrenal Myelolipoma is a rare benign neoplasm, which contains mature adipose tissue and variable amounts of haematopoietic elements. Most lesions are small and asymptomatic, discovered incidentally during autopsy or imaging studies performed for other reasons. CASE PRESENTATION Here we reported a series of two cases of giant myelolipomas of the adrenal gland; first one the largest tumor reported so far presented with massive hemorrhage and the second case introduced with its rare unreported presentation of adrenal myelolipomas i.e. a large abscess. DISCUSSION Adrenal myelolipoma is a rare and asymptomatic tumor usually discovered incidentally in less than 1% of population on autopsy or imaging performed for other reasons. There is an increasing incidence of large adrenal myelolipoma (> 10 cm) presenting with life threatening and recurrent retroperitoneal hemorrhage along with other complications as abscess. To avoid such a life-threatening situation, authors recommend close monitoring and consideration of urgent surgical intervention for tumors larger than 4 cm at presentation or increase in size or change in appearance during follow-up.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Jayant
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Prasad
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Agrawal
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kalpesh Mahesh Parma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Roat
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushal Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Su HC, Huang X, Zhou WL, Dai J, Huang BX, Cao WL, Sun FK. Pathologic analysis, diagnosis and treatment of adrenal myelolipoma. Can Urol Assoc J 2014; 8:E637-40. [PMID: 25295136 DOI: 10.5489/cuaj.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the widespread use of non-invasive imaging modalities, the incidental detection of myelolipoma has become more common. We analyze the clinical data of 4 typical cases of unilateral adrenal myelolipomas, including 1 hormonally inactive patient and 3 hormonally active cases with hyperaldosteronemia, hypercortisolism and hyperandrogenemia. Obvious differences were found in the pathological sections. To our knowledge, this is the first article discussing the etiology of adrenal myelolipoma from pathologic analyses.
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Affiliation(s)
- Heng-Chuan Su
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xin Huang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wen-Long Zhou
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Dai
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bao-Xing Huang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wan-Li Cao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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12
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Zorgdrager M, Pol R, van Hemel B, van Ginkel R. Giant adrenal myelolipoma: when trauma and oncology collide. BMJ Case Rep 2014; 2014:bcr-2014-204023. [PMID: 24872487 DOI: 10.1136/bcr-2014-204023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Three patients presented some decades after severe traumatic injury with atypical bowel symptoms which were caused by a giant myelolipoma of the adrenal gland. The aetiology of this rare, benign and generally asymptomatic tumour is virtually unknown at present and several hypotheses have been devised. This report describes a possible association between high-energy trauma and the development of giant myelolipomas, further contributing to the hypothesis that severe systemic stress could be an aetiological factor in the development of an adrenal myelolipoma.
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Affiliation(s)
- Marcel Zorgdrager
- Department of Surgery, University of Groningen, UMCG, Groningen, The Netherlands
| | - Robert Pol
- Department of Surgery, University of Groningen, UMCG, Groningen, The Netherlands
| | - Bettien van Hemel
- Department of Pathology, University of Groningen, UMCG, Groningen, The Netherlands
| | - Robert van Ginkel
- Department of Surgery, University of Groningen, UMCG, Groningen, The Netherlands
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13
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Joy PS, Marak CP, Nashed NS, Guddati AK. Giant adrenal myelolipoma masquerading as heart failure. Case Rep Oncol 2014; 7:182-7. [PMID: 24748868 PMCID: PMC3985784 DOI: 10.1159/000360981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging. However, myelolipomas may insidiously grow to large sizes and cause mass effects and hemorrhage. Timely diagnosis and surgical resection are curative and lifesaving.
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Affiliation(s)
- Parijat S Joy
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, and University of Iowa Carver College of Medicine, Iowa, Iowa., USA
| | - Creticus P Marak
- Division of Pulmonary Medicine, Department of Medicine, Tahlequah City Hospital, Tahlequah, Okla., USA
| | - Nadia S Nashed
- Department of Pathology, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, Pa., USA
| | - Achuta K Guddati
- Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Harvard University, Boston, Mass., USA
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14
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An unusual fat-containing presacral tumor in an elderly patient. Case Rep Radiol 2014; 2014:674365. [PMID: 24653850 PMCID: PMC3933520 DOI: 10.1155/2014/674365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/31/2013] [Indexed: 12/27/2022] Open
Abstract
The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper.
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15
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Suárez-Peñaranda JM, Bermúdez Naveira A, Fraga M, Aliste-Santos C, Cordeiro C, Muñoz-Barús JI. Unusual Forms of Adrenal and Extra-Adrenal Myelolipomas. Int J Surg Pathol 2014; 22:473-7. [PMID: 24492331 DOI: 10.1177/1066896914521289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Myelolipomas are rare benign tumors of poorly understood tumorigenesis composed of mature hematopoietic tissue and fat. They mostly occur in the adrenal glands, but extra-adrenal myelolipomas have been reported in other locations such as the presacral region or retroperitoneum. It is not unusual that they are incidental findings revealed in the study of different diseases. We report 3 unusual examples of myelolipomas. The first is a multiple, unusually large, extra-adrenal myelolipoma, presented as an autopsy finding in an individual who had died suddenly from a central nervous system hemorrhage. The remaining 2 were incidental findings in patients studied for different reasons. Both were located within another neoplasm, namely an adrenal adenoma and a liver focal nodular hyperplasia. Moreover, the first showed infiltration by a non-Hodgkin lymphoma.
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Affiliation(s)
- José Manuel Suárez-Peñaranda
- Clinical Hospital, Santiago de Compostela, Spain University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Máximo Fraga
- Clinical Hospital, Santiago de Compostela, Spain University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Cristina Cordeiro
- National Institute of Legal Medicine and Forensic Sciences, Centre Branch, Portugal Faculty of Medicine, University of Coimbra, Portugal CENCIFOR (Centre of Forensic Science and Technology) Foundation for Science and Technology, Portugal
| | - José Ignacio Muñoz-Barús
- University of Santiago de Compostela, Santiago de Compostela, Spain Institute of Forensic Sciences, University of Santiago de Compostela, Spain
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Yin L, Teng J, Zhou Q, Liu Y, Yao Y, Gao Y, Cui X, Ren J, Xu D. A 10-year single-center experience with surgical management of adrenal myelolipoma. J Endourol 2013; 28:252-5. [PMID: 24044410 DOI: 10.1089/end.2013.0283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose is to report our 10-year experience with surgical management of large or symptomatic adrenal myelolipoma. PATIENTS AND METHODS Patients receiving surgical treatment for adrenal myelolipoma between December 2001 and September 2011 in our institution were retrospectively reviewed. Patients were divided into two groups: open surgery and laparoscopic surgery. Patient demographic data, lesion size evaluated by computed tomography scan or magnetic resonance imaging, operation time, blood loss, time of returning to diets, perioperative complications, and length of hospital stay were collected and analyzed. RESULTS Forty patients (14 received open surgery and 26 received laparoscopic surgery) were enrolled in our study. Both procedures were successful and no patient in the retroperitoneal laparoscopic group required conversion to open surgery. The mean age of the patients was 52.7 years. The median size of the tumor was 5.0 cm. Forty-three percent of patients suffered from lumbago. There was no statistical difference in perioperative complications between the two groups (p>0.05). Retroperitoneal laparoscopic adrenalectomy patients had a shorter operation time (90.66±37.97 min vs 141.82±62.78 min, p=0.017), less blood loss (150, 100-200 mL vs 450, 300-525 mL, p=0.000), earlier time of returning to diets (2, 2-3 days vs 3, 2-4.5 days, p=0.036), and a shorter hospital stay (6, 5-7 days vs 10, 8-11.25 days, p=0.000) when compared with open surgery patients. CONCLUSION Both open and laparoscopic surgeries are efficient and safe treatments for large or symptomatic adrenal myelolipoma, and retroperitoneal laparoscopic surgery has the advantages of minimal invasion and rapid postoperative recovery.
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Affiliation(s)
- Lei Yin
- 1 Department of Urology, Changzheng Hospital, The Second Military Medical University , Shanghai, China
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Incidental detection of adrenal myelolipoma: a case report and review of literature. Case Rep Urol 2013; 2013:789481. [PMID: 23509660 PMCID: PMC3590507 DOI: 10.1155/2013/789481] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/20/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction. Adrenal myelolipoma is a rare tumor that is benign in nature, usually asymptomatic, unilateral, and nonsecreting. It is composed of variable mixture of mature adipose tissue and hematopoietic elements and develops within the adrenal gland. With the widespread use of cross-sectional imaging modalities such as ultrasonography and computed tomography, the incidental detection of these tumors is increasing in frequency. Case Presentation. We report a case of adrenal myelolipoma in a 63-year-old Kashmiri male, who presented with pain in the right upper abdomen. Physical examination was unremarkable. Ultrasound abdomen showed the presence of a hyperechoic mass in the right suprarenal region with undefined margins. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed a well-defined, round lesion in the right suprarenal region with heterogeneous attenuation suggesting the possibility of myelolipoma. The patient was subjected to right adrenalectomy and his postoperative course was uneventful. The histopathological evaluation of the mass confirmed the initial diagnosis of adrenal myelolipoma. Conclusion. Although mostly discovered as an "incidentaloma", the diagnosis of adrenal myelolipoma warrants thorough diagnostic study. Imaging techniques such as ultrasonography and CT scans as well as biochemical studies are useful for indicating the best treatment taking into account the size of the mass and possible hormone production. Surgical resection is advocated through extraperitoneal approach as it minimizes postoperative complications and leads to quicker recovery.
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Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiol Clin North Am 2012; 50:219-43, v. [PMID: 22498440 DOI: 10.1016/j.rcl.2012.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discovery of an incidental adrenal mass (adrenal incidentaloma) continues to rise with the increasing use of cross-sectional imaging. Although most adrenal lesions are benign and asymptomatic, radiologists should guide evaluation of these lesions, whether benign or malignant. This article reviews the various imaging techniques used to evaluate adrenal masses and their relative strengths and weaknesses. It focuses on the most prevalent adrenal pathologies and their typical imaging characteristics, and concludes with a brief discussion of developing techniques, including diffusion-weighted imaging and dual-energy CT.
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Affiliation(s)
- Myles Taffel
- Department of Radiology, George Washington University Medical Center, Washington, DC, USA.
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Khater N, Khauli R. Myelolipomas and other fatty tumours of the adrenals. Arab J Urol 2011; 9:259-65. [PMID: 26579309 PMCID: PMC4150587 DOI: 10.1016/j.aju.2011.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/04/2011] [Accepted: 10/13/2011] [Indexed: 01/05/2023] Open
Abstract
Background Lipomatous tumours of the adrenals are almost always benign. The importance of recognising their characteristic radiological features, leading to their correct treatment, is fundamental, as there has been an increase in the identification of these lesions. Our goal was to review all lipomatous tumours of the adrenal glands, particularly myelolipomas, their imaging methods and surgical management, updated in 2011. Methods This was a retrospective review of articles published in the USA and Europe, from 1979 to date. The sites from which information was retrieved covered PubMed, Medscape, Clinical Imaging, Histopathology, Urologia Internationalis, Archives of Surgery, JACS, the American Urological Association, BMJ, Medline, and Springer Link. We report areas of controversies in addition to well established guidelines. Results We reviewed 45 articles, that confirmed, with a high level of evidence-based medicine, that the diagnosis of a lipomatous adrenal tumour is made by various imaging procedures, particularly computed tomography (CT). We emphasise the importance to their management of the initial size of the adrenal mass, its increase in size over time, in addition to the presence of symptoms. Conclusion Lipomatous tumours of the adrenals are most frequently benign. The diagnosis is usually made by various techniques, in particular CT. The fundamental characteristics indicating the necessity of surgical intervention are the symptoms presented, volume of the tumoral mass (>5 cm), and the increase in size of the tumour as shown in two consecutive imaging studies.
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Affiliation(s)
- Nazih Khater
- American University of Beirut, Division of Urology, Beirut, Lebanon
| | - Raja Khauli
- American University of Beirut, Division of Urology, Beirut, Lebanon
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20
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Shin NY, Kim MJ, Chung JJ, Chung YE, Choi JY, Park YN. The differential imaging features of fat-containing tumors in the peritoneal cavity and retroperitoneum: the radiologic-pathologic correlation. Korean J Radiol 2010; 11:333-45. [PMID: 20461188 PMCID: PMC2864861 DOI: 10.3348/kjr.2010.11.3.333] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 02/01/2010] [Indexed: 12/17/2022] Open
Abstract
There are a variety of fat-containing lesions that can arise in the intraperitoneal cavity and retroperitoneal space. Some of these fat-containing lesions, such as liposarcoma and retroperitoneal teratoma, have to be resected, although resection can be deferred for others, such as adrenal adenoma, myelolipoma, angiomyolipoma, ovarian teratoma, and lipoma, until the lesions become large or symptomatic. The third group tumors (i.e., mesenteric panniculitis and pseudolipoma of Glisson's capsule) require medical treatment or no treatment at all. Identifying factors such as whether the fat is macroscopic or microscopic within the lesion, the origin of the lesions, and the presence of combined calcification is important for narrowing the differential diagnosis. The development and wide-spread use of modern imaging modalities make identification of these factors easier so narrowing the differential diagnosis is possible. At the same time, lesions that do not require immediate treatment are being incidentally found at an increasing rate with these same imaging techniques. Thus, the questions about the treatment methods have become increasingly important. Classifying lesions in terms of the necessity of performing surgical treatment can provide important information to clinicians, and this is the one of a radiologist's key responsibilities.
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Affiliation(s)
- Na-young Shin
- Department of Radiology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
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21
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Giant adrenal myelolipoma, a rare urological issue with increasing incidence: a case report. CASES JOURNAL 2009; 2:8863. [PMID: 19918346 PMCID: PMC2769476 DOI: 10.4076/1757-1626-2-8863] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 08/11/2009] [Indexed: 02/01/2023]
Abstract
Introduction Adrenal myelolipomas are relatively rare, non-functioning benign tumours composed of mature fatty and active hematopoietic elements. They can be asymptomatic, even if their size is massive. Diagnosis is relatively simple using ultrasound, computed tomography and magnetic resonance imaging. Surgical resection through an extraperitoneal approach is advocated in cases of symptomatic or large myelolipomas exceeding 5-cm in diameter. Their low incidence seems to be increasing from 0.2% to 10% during the last decade. Case presentation We present a case of a giant adrenal myelolipoma in a 68-year-old Caucasian male, who was presented with left lumbar pain. Renal ultrasound, CT and MRI demonstrated a well demarcated mass, with a maximum diameter of 10-cm. The differential diagnosis comprised the adrenal myelolipoma, the retroperitoneal liposarcoma and the renal angiomyolipoma. Thus, the patient was subjected to a left adrenalectomy. Conclusion Multiple theories have been proposed for the increasing frequency and natural course of the adrenal myelolipoma, with chronic adrenal stimulation and the contemporary stressful lifestyle to be the most appealing. Surgical treatment is advocated through an extraperitoneal approach because of the quicker recovery of the patient and the smaller postoperative complication rate.
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AJR Teaching File: Fat-Containing Retroperitoneal Mass Presenting With Acute Flank Pain. AJR Am J Roentgenol 2009; 192:S122-4. [DOI: 10.2214/ajr.07.7007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Olivar Roldán J, Molina Baena B, Pavón de Paz I, Iglesias Bolaños P, Montoya Álvarez T, Fernández Martínez A. Giant adrenal myelolipoma: case report and literature review. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2008; 55:139-141. [PMID: 22967880 DOI: 10.1016/s1575-0922(08)70650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 09/15/2007] [Indexed: 06/01/2023]
Abstract
Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma and provide a review of the literature.
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Affiliation(s)
- Juana Olivar Roldán
- Servicio De Endocrinología Y Nutrición. Hospital Universitario De Getafe. Getafe. Madrid. España
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Timonera ER, Paiva ME, Lopes JM, Eloy C, van der Kwast T, Asa SL. Composite adenomatoid tumor and myelolipoma of adrenal gland: report of 2 cases. Arch Pathol Lab Med 2008; 132:265-7. [PMID: 18251587 DOI: 10.5858/2008-132-265-catamo] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2007] [Indexed: 11/06/2022]
Abstract
Adenomatoid tumor and myelolipoma are benign, hormonally inactive tumors that are often incidental findings in the adrenal glands. Myelolipoma is more common than adenomatoid tumor in this location but both are rare, and as yet, the pathogenesis of both remains unclear. We report 2 cases of composite adenomatoid tumor and myelolipoma, incidentally found in the adrenal gland on investigation for other diseases. To our knowledge, composite adenomatoid tumor and myelolipoma of adrenal gland has not been previously reported.
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Affiliation(s)
- Elizabeth R Timonera
- Department of Pathology, University Health Network, University of Toronto, Ontario, Canada M5G 2C4
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25
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Bilateral adrenal myelolipoma associated with hyperaldosteronism: report of a case and review of the literature. Urology 2008; 70:1223.e11-3. [PMID: 18158060 DOI: 10.1016/j.urology.2007.09.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/08/2007] [Accepted: 09/20/2007] [Indexed: 12/20/2022]
Abstract
Adrenal myelolipoma is a rare benign tumor composed of mature adipose cells and hematopoietic elements. Although they are not hormonally active, there is very rarely an association with functional adrenal disorders. We report a case of bilateral adrenal myelolipoma associated with primary hyperaldosteronism. To our knowledge, this is the first bilateral adrenal myelolipomas reported to date in association with primary hyperaldosteronism.
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Polamaung W, Wisedopas N, Vasinanukorn P, Pak-art P, Snabboon T. Asymptomatic bilateral giant adrenal myelolipomas: case report and review of literature. Endocr Pract 2008; 13:667-71. [PMID: 17954426 DOI: 10.4158/ep.13.6.667] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe an unusual case of bilateral giant adrenal masses caused by a primary adrenal myelolipoma. METHODS We present the clinical, laboratory, and pathologic findings in a 32-year-old man with bilateral adrenal masses. The previous reports of bilateral myelolipomas also were reviewed. RESULTS During a routine examination, a 32-year-old Thai man was found to have an asymptomatic abdominal mass. A computed tomographic scan of the abdomen disclosed bilateral adrenal masses; the one on the left was approximately 27 by 24 by 12 cm, and the one on the right side was 9 by 5 by 5 cm. The computed tomographic scan characteristics showed that both masses consisted mainly of low-density tissues (-30 to -90 Hounsfield units), suggestive of fatty component. An endocrinologic evaluation revealed no evidence of adrenal cortical or medullary functional abnormalities. Bilateral adrenalectomy was performed because of the large size of the lesions and the inability to rule out malignant involvement. CONCLUSION Myelolipoma is a relatively rare benign tumor of the adrenal glands composed of adipose cells and mature hematopoietic elements. Most such lesions are small, asymptomatic, and unilateral; giant or bilateral myelolipomas are quite rare. To our knowledge, our current case may represent the largest bilateral lesions in the literature.
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Affiliation(s)
- Waraporn Polamaung
- Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
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Lesbats-Jacquot V, Cucchi JM, Amoretti N, Novellas S, Chevallier P, Bruneton JN. Lipomatous tumors of the adrenals--a report on 18 cases and review of the literature. Clin Imaging 2007; 31:335-9. [PMID: 17825742 DOI: 10.1016/j.clinimag.2007.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 04/28/2007] [Indexed: 01/27/2023]
Abstract
The lipomatous tumors of the adrenals are hormonally inactive lesions, often of a benign nature, such as myelolipomas, lipomas, angiomyolipomas, or mature teratomas, and are rarely malignant, such as liposarcomas. The importance of recognizing their characteristic radiological images, which would lead to their correct treatment, is fundamental since there has been an increase in the demonstration of this lesion, often detected incidentally. The various imaging procedures, although not allowing to formulate a histological diagnosis, nonetheless permit to determine the volume of the tumoral mass and their evolution. These two factors are of significant importance in the planning of the correct surgical procedure, while a third important factor is the proper evaluation of the symptoms presented by the patient. Regarding the treatment, on the basis of our own experience, which agrees with that of other authors, the surgical removal of any lesion greater than 5 cm is mandatory.
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Affiliation(s)
- Virginie Lesbats-Jacquot
- Service d'imagerie diagnostique et interventionelle, Hôzpital de l'Archet II, 151 rte St Antoine de Ginestiére, F-06200 Nice, France.
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Affiliation(s)
- William F Young
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Patel VG, Babalola OA, Fortson JK, Weaver WL. Adrenal Myelolipoma: Report of a Case and Review of the Literature. Am Surg 2006. [DOI: 10.1177/000313480607200716] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adrenal myelolipoma is a rare benign tumor composed of mature lipomatous and hemopoietic tissue. Although it is often discovered as an incidental finding on imaging of the abdomen for some other reason or at autopsy, adrenal myelolipoma has been reported to present with symptoms such as flank pain resulting from tumor bulk, necrosis, or spontaneous retroperitoneal hemorrhage. Myelolipomas are hormonally inactive but have also been reported to coexist with other hormonally active tumors of the adrenal gland. They are usually unilateral but may be bilateral and may also develop in extraadrenal sites like the retroperitoneum, thorax, and pelvis. We report a patient with symptomatic adrenal myelolipoma diagnosed on computed tomography scan and confirmed on computed tomography-guided biopsy. The patient underwent surgical resection for symptomatic relief. We also review the literature to evaluate the presentation and optimal management of this rare adrenal tumor that is not encountered by most general surgeons and therefore not well known to most surgeons.
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Affiliation(s)
- Vijaykumar G. Patel
- From the Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Olufemi A. Babalola
- From the Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - James K. Fortson
- From the Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - William L. Weaver
- From the Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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Mo KI, Kim DG, Lee KS, Kwen SW, Seo YJ. Adrenal Myelolipoma Treated with Hand-assisted Transperitoneal Laparoscopic Adrenalectomy. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.7.791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyo Ik Mo
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Dae Gon Kim
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Kyung Seop Lee
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Soon Weon Kwen
- Department of Urology, Sunlin Hospital, Handong University, Pohang, Korea
| | - Young Jin Seo
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
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