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.
Highlights
Myelolipomas are benign tumors composed of both mature adipose and hematopoietic elements, most commonly occurring in the adrenal glands [1, 2]
This case report alerts to the possibility of presacral myelolipomas, which have been only occasionally reported in the literature but should be considered in the differential diagnosis of every fat-containing tumor occurring in this region [3,4,5,6,7,8,9,10]
Extra-adrenal myelolipomas are benign nonfunctioning tumors composed of mature adipose tissue and trilineage hematopoietic cells
Summary
Myelolipomas are benign tumors composed of both mature adipose and hematopoietic elements, most commonly occurring in the adrenal glands [1, 2]. The imaging findings of these tumors completely overlap with those of their adrenal counterpart, as was observed in this case. Notwithstanding, other possible presacral tumors, such as teratomas and liposarcomas, may have similar CT and MRI appearance and the definite diagnosis still requires histological confirmation [8,9,10,11,12]
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