Adrenal myelolipoma: Report of a case and review of the literature

Department of Surgery, Morehouse School of Medicine, 720 Westview Dr., SW, Atlanta, GA 30310, USA.
The American surgeon (Impact Factor: 0.82). 08/2006; 72(7):649-54.
Source: PubMed


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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    • "Although many of these features are quite useful in distinguishing benign adrenal adenomas from adrenocortical carcinomas (particularly lesion size and washout), they have not been established as adequate markers for the distinction between adrenocortical carcinomas and other benign adrenal lesions such as myelolipoma . Myelolipomas are benign tumors usually arising from the adrenal gland that contain a combination of hematopoietic tissue and mature adipose tissue[4]. Myelolipomas are not rare adrenal lesions as they have been shown to comprise 6% of all adrenal lesions identified in patients with no known malignancy[13]. Although other rare macroscopic fat-containing lesions have been shown to occur in the adrenal gland (including primary adrenal lipomas, liposarcomas, collision tumors, teratomas , and potentially pheochromocytomas)[5,12], the Figure 1Axial sections of contrast-enhanced CT (A, B), and coronal reformatted (C), demonstrating a large heterogeneous mass in the left upper quadrant with a heterogeneous predominantly peripheral nodular enhancement, central low attenuation representing necrosis, and a small focus of fat density (À23 HU) representative of macroscopic fat. "
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    ABSTRACT: The presence of macroscopic fat in an adrenal mass has classically been associated with myelolipoma. Adrenocortical carcinoma is typically an aggressive malignancy with a poor prognosis. The presence of macroscopic fat is not a characteristic finding in adrenocortical carcinoma or other adrenal malignancies. We report a case of a newly discovered large adrenal mass containing multiple areas of macroscopic fat, which was pathologically proven to represent an adrenocortical carcinoma.
    Full-text · Article · Nov 2010 · Cancer Imaging
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    • "Only about 50 cases of extra-adrenal myelolipomas were reported yet in the literature [3]. The occurrence of most extra-adrenal myelolipomas were noted in the presacral soft tissue, followed by the retroperitoneum, the pelvis the stomach and in the musclefascial as well as a few have been reported in the perirenal tissue [1,3,4,8,9,14-18]. The aetiology of myelolipomas in general is so far unknown, although derivation from bone marrow tissue is discussed [2]. "
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    ABSTRACT: Extra-adrenal myelolipomas are rare benign tumours. Other soft tissue tumours such as well-differentiated liposarcomas appear morphological almost identical. Preoperative imaging and especially biopsy are important tools to diagnose these lesions. We report a very seldom case of a simultaneous myelolipoma of the adrenal gland in association with an extra-adrenal myelolipoma in an 75-year-old man. With a review of the literature we describe and discuss the aetiology, differential diagnosis and treatment of patients with respect to adrenal and extra-adrenal lesions. The appearance of a simultaneous adrenal and extra-adrenal myelolipoma is a rare incident. We conclude that such lesions should be considered in the differential diagnosis of a fat-containing tumour in the retroperitoneal tissue/compartment.
    Full-text · Article · Feb 2008 · World Journal of Surgical Oncology
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    ABSTRACT: Adrenal glands are common sites of diseases. With dramatically increased use of computed tomography (CT) and magnetic resonance (MR) imaging, more and more uncommon adrenal masses have been detected incidentally at abdominal examinations performed for other purposes. In this article, uncommon adrenal masses are classified as cystic masses (endothelial cysts, epithelial cysts, parasitic cysts, and pseudocysts), solid masses (ganglioneuroma, ganglioneuroblastoma, extramedullary plasmacytoma (EMP), neurilemmoma, and lymphoma), fat-containing masses (myelolipoma, teratoma), and infectious masses (tuberculoma), and the imaging features of these uncommon masses are demonstrated. Although most of these lesions do not have specific imaging features, some fat-containing masses and cystic lesions present with characteristic appearances, such as myelolipoma, teratoma, and hydatid. Combination with histopathologic characteristic of these uncommon masses of adrenal gland, radiological features of these lesions on CT and MR imaging can be accurately understood with more confidences. Moreover, CT and MRI are highly accurate in localization of uncommon adrenal masses, and useful to guide surgical treatments.
    No preview · Article · Jul 2007 · European Journal of Radiology
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