Bilateral extra-adrenal perirenal myelolipomas: a case report

Abstract

BackgroundMyelolipomas are mesenchymal tumors usually involving the adrenal gland. They are a rare entity with incidence ranging from 0.08 to 0.4% as per autopsy reports. Only 15% of these are in extra-adrenal locations such as pelvis, retroperitoneum, mediastinum, lungs, stomach, liver, spleen and kidneys. Very few (only 3) cases of bilateral extra-adrenal perirenal myelolipomas have been reported until now; and one such case has been presented in our case report.Case presentationA 45-year-old male presented with abdominal distension and bilateral lower limb edema for 2 months. Renal functions were mildly deranged. Ultrasound was suggestive of perirenal masses. CT scan of the abdomen confirmed the diagnosis of bilateral extra-adrenal, perirenal myelolipoma. The differentials of lipomatous retroperitoneal tumors were considered. Core biopsy from perirenal masses revealed adipose tissue with interspersed hematopoietic precursors.ConclusionExtra-adrenal myelolipoma are rare tumors that are not known to have malignant potential and may be symptomatic only due to mass effect. Diagnosis can be confirmed by imaging in most cases. Histopathology may not be able to confirm malignancy even in sarcoma if sample is not taken from the appropriate site, usually non-fatty soft-tissue components. This rare case is presented in order to add to literature, the varied presentations of extra-adrenal myelolipomas.