• Case report
• Myelolipoma
• Ribs
• Thoracotomy

• Humans
• Myelolipoma/surgery
• Myelolipoma/pathology
• Myelolipoma/diagnosis
• Myelolipoma/diagnostic imaging
• Female
• Ribs/pathology
• Ribs/surgery
• Ribs/diagnostic imaging
• Young Adult
• Thoracotomy
• Chest Pain/etiology
• Tomography, X-Ray Computed
• Treatment Outcome
• Bone Neoplasms/surgery
• Bone Neoplasms/pathology
• Bone Neoplasms/diagnostic imaging
• Bone Neoplasms/diagnosis

• Anatomy
• Extraperitoneal spaces
• Pathologic fluid
• Retroperitoneal spaces
• Retroperitoneum

Extra-adrenal myelolipomas are rare, asymptomatic entities, although large tumors may cause local symptoms or hemorrhage. When these lesions occur outside the adrenals in the retroperitoneum, they are radiographically easily confused with both primary and secondary retroperitoneal tumors, which tend to be aggressive. Although myelolipomas are benign and can be managed conservatively, if malignancy is suspected, a surgical procedure is an option. We report a case of a 68-year-old patient with multiple perirenal extra-adrenal myelolipomas. Initial abdominal ultrasound reviled an inhomogeneous mass surrounding the left kidney. Subsequent CT examination of the abdomen showed four separate, extrarenal, well-circumscribed, round-shaped, fat-containing retroperitoneal tumors. Given the significant size of the masses, that compressed major abdominal vessels and the suspicion of liposarcoma, a surgical excision of the lesions was performed. The tumors were easily separated, all surrounding structures were spared, and they were removed completely. Histologically, all masses consisted of hematopoietic and mature fat tissue and the final diagnosis was extra-adrenal myelolipoma. The patient was released from the hospital 7th day after surgery in good condition and at his baseline. Since myelolipomas are, by definition, nonfunctional benign tumors, there was no need for further follow-up. The radiological evaluation and fine needle biopsy are usually sufficient to establish the diagnosis, but in some cases of well-differentiated liposarcoma, the differentiation between myelolipoma and liposarcoma can be challenging. Therefore, considering that myelolipomas and liposarcomas have opposite prognoses, which affects the surgeon's decision on the extent of surgical procedure and further treatment, we also emphasize the importance of intraoperative assessment of the tumor, both by the surgeon and by intraoperative pathology consultation.

Myelolipomas are rare benign neoplasms that commonly develop in the adrenal glands. Less frequently, they can affect other organs such as the liver, stomach, liver, lung, and retroperitoneum. It affects more women, with an average age of around 61 years. Histologically, they are composed of mature adipose tissue and hematopoietic cells. With the evolution of immunohistochemistry, there are characteristics that can differentiate from malignant tumors such as liposarcomas. Its treatment remains based on surgical resection and long-term outpatient follow-up.

Extra-adrenal myelolipomas are exceedingly rare benign tumors composed of adipose and myeloid tissues, which have been reported to occur in various sites including the retroperitoneum, pelvis, and thorax. Myelolipomas are more commonly encountered in the adrenal glands. We illustrate a case of a 72-year-old woman with surgically proven bilateral perirenal and para-aortic lymph nodal myelolipomas detected incidentally by computed tomography. Extra-adrenal myelolipomas can be difficult to distinguish from other fat-containing lesions particularly liposarcomas, which are more commonly encountered in the retroperitoneum. This case highlights the unusual multifocal involvement of extra-adrenal myelolipomas and despite its rare occurrence, should be included in the differential diagnosis of retroperitoneal lipomatous lesions.

• Case report
• Extra-adrenal myelolipoma
• Hepatic myelolipoma
• Liver
• Liver neoplasms
• Myelolipoma
• Tumor

Primary retroperitoneal masses constitute a heterogeneous group of uncommon lesions and represent a challenge due to overlapping imaging findings. Most are malignant lesions. Although they are more prevalent in adults, they can occur at any age. Such lesions are classified as primary when they do not originate from a specific retroperitoneal organ and are divided, according to the image findings, into two major groups: solid and cystic. The clinical findings are nonspecific and vary depending on the location of the lesion in relation to adjacent structures, as well as on its behavior. The main imaging methods used for staging and surgical planning, as well as for selecting the biopsy site and guiding the biopsy procedure, are computed tomography and magnetic resonance imaging. In most cases, the treatment is challenging, because of the size of the lesions, vascular involvement, or involvement of adjacent organs. In this article, we present a review of the retroperitoneal anatomy and a practical approach to the main imaging features to be evaluated, with a view to the differential diagnosis, which can guide the clinical management.

• Magnetic resonance imaging
• Retroperitoneal neoplasms/diagnosis
• Retroperitoneal space/anatomy & histology
• Tomography, X-ray computed

• hematuria
• radiology
• urological surgery

• Adult
• Female
• Humans
• Kidney Neoplasms/pathology
• Myelolipoma/pathology
• Ureteral Neoplasms/pathology

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male.