Adrenal Myelolipoma: Case Report

Abstract

Introduction: Myelolipomas were first described in 1905 as an adrenal tumor composed of mature fat mixed with myeloid and erythroid cells. Adrenal myelolipomas are the second most common benign type of tumor in the adrenals, following after adrenocortical adenomas. It is mostly discovered incidentally on imaging of abdomen done for non-adrenal related reasons or at autopsy. Symptomatic tumors, growing tumors or tumors larger than 10 cm should be excised surgically. We report the case of 1 male patient presenting with flank pain and upper pole renal masse, treated surgically with adrenalectomy. Myelolipoma was confirmed on histology. Case presentation: a 46-years-old male, with a history of blood hypertension, presented with persistent abdominal discomfort and occasional pain in the right flank region. Physical examination revealed a non-tender palpable mass in the right upper quadrant of the abdomen. The abdominal CT scan revealed a large well-defined retroperitoneal tumor, which compressed and displaced the right kidney downward, the mass was heterogeneous with areas of soft-tissue attenuation. The patient underwent open left adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma. The differential diagnosis of fat-containing retroperitoneal masses would include retroperitoneal lipoma or liposarcoma and renal angiomyolipoma. Discussion: Adrenal myelolipomas are the second most common adrenal incidentalomas comprising 6 to 16% of adrenal incidentalomas. The size of adrenal myelolipomas is variable and can range from a few millimeters to greater than 10 cm. These are called giant adrenal myelolipomas. The largest adrenal myelolipoma reported to date weighed 6 kg. Extra-adrenal sites for myelolipomas include the retroperitoneum, thorax, and pelvis. Usually unilateral however they can also involve both adrenals. The most common symptoms observed are abdominal discomfort/pain, hypochondrial pain, and flank pain. Ultrasonography (USG), ......