Abstract
IntroductionAdrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting. It develops within the adrenal gland and is composed of mature adipose tissue with elements of the hematopoietic series. We describe the case of what is, to the best of our knowledge, one of the largest secreting adrenal myelolipomas reported in the literature.Case presentationA 52-year-old Caucasian man of medium build who had had moderate hypertension for three years presented to our hospital. He had no other significant symptoms. His hypertension was pharmacologically treated. He came to our hospital to undergo abdominal ultrasonography during a clinical checkup. The ultrasound scan showed the presence of a voluminous hyperechoic mass interposed between the spleen and the left kidney. It was reported as a myelolipoma of the left kidney on the basis of its structural characteristics and position. Computed tomography confirmed our diagnosis. All preoperative biochemical tests were normal, with the exception of high serum cortisol, which was being overproduced by the lesion and was probably responsible for the patient's hypertension. He underwent successful surgery, and his postoperative course was uneventful. The pathologic examination of the lesion confirmed the diagnosis of adrenal myelolipoma. The patient's blood pressure returned to within the normal range.ConclusionsThe "incidental" discovery of an adrenal mass requires careful diagnostic study to plan adequate therapeutic management. Both of the primary investigations at our disposal, ultrasound and blood tests (adrenal hormones), helped in rendering the diagnosis and allowed us to move toward the most appropriate treatment, taking into account the size of the tumor and its probable hormonal production.
Highlights
Adrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting
The myelolipoma is a rare, benign neoplasm composed of mature adipocytes and hematopoietic tissue
Adrenal myelolipoma is often an “incidentaloma,” since its diagnosis is frequently based on autopsic findings or upon diagnostic imaging examinations performed for reasons unrelated to its presence
Summary
The “incidental” discovery of an adrenal mass requires careful diagnostic study to plan an appropriate treatment. Imaging techniques at our disposal today can help the clinician to render the diagnosis. Since myelolipomas consist mainly of adipose tissue, their sharp hyperechogenicity observed on US may orient the clinician toward the diagnosis, but US does not yield any certain detail about nature of lipomatous lesions. CT can clarify the nature of incidentalomas, as in our patient, and can indicate the best treatment, taking into consideration the tumor size and its possible hormone production. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. AB and RF took care of the patient during his hospitalization. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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