Adrenal myelolipoma

Adrenal myelolipoma with hyperandrogenemia and schizophrenia

Adrenal myelolipoma with hyperandrogenemia is extremely rare. We report a case of a 26-year-old Chinese female with schizophrenia, who presented with a hormonally active tumor causing hyperandrogenemia. The mass was found by computerized tomography when she had her gynecologic examination for secondary amenorrhea, and it was confirmed to be an adrenal myelolipoma after a histopathological study. She was referred for a left adrenal laparoscopic excision, and the size of adrenal myelolipoma was found to be more than 10 cm. We report this case because large adrenal myelolipomas with hyperandrogenemia and schizophrenia are rare, and adrenal myelolipoma associated with hyperandrogenemia might be determined by the enzymes involved in the production of hormones.

Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia

Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-α hydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing's syndrome, Addison's disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.

Hemorrhagic myelolipoma of adrenal gland after blunt trauma

A case of adrenal myelolipoma is reported in a patient in whom symptoms of hematuria and flank pain developed after the patient had sustained blunt trauma. Adrenal myelolipomas are usually found incidentally at autopsy. However, the symptomatic presentation of this patient was probably caused by traumatic intratumor hemorrhage. The etiology and pathogenesis of these tumors are discussed in relation to their occasional symptomatic presentation and to their differential diagnosis.

Adrenal myelolipoma: a case report and review of the literature

A case of a 73 year old man who was preoperatively diagnosed as possibly having myelolipoma is presented herein. Adrenal myelolipoma is an uncommon benign tumor of which only 74 foreign cases and 43 Japanese cases have been previously reported in the literature dealing with surgically removed myelolipomas. The most consistent complaint of the adrenal myelolipoma sufferer is abdominal pain, caused by hemorrhaging in the tumor, and many cases are associated with obesity, hypertension and/or diabetes mellitus. There is now an increasing number of such cases being diagnosed during abdominal scanning with ultrasonography or computerized tomography for unrelated problems, whereupon the myelolipoma is usually surgically resected. With the availability of modern scanning techniques and fine needle biopsy, however, it should be possible to adopt a more conservative approach to the management of asymptomatic adrenal myelolipoma. Nevertheless, symptomatic or large tumors, must be removed since there is a high risk of spontaneous hemorrhage.

Adrenal myelolipoma: clinical, radiologic, and histologic features

The adrenal myelolipoma is a benign, endocrinologically inactive tumor whose histologic structure consists of mature adipose tissue with foci of hematopoietic cells. A case is presented of a seventy-one-year-old woman in whom the diagnosis was established preoperatively by means of sonography, computerized tomography, and magnetic resonance tomography. In a review of the literature, the radiologic profile is discussed, and based on the analysis of 59 surgically treated cases a therapy recommendation is given.

Adrenal myelolipoma: report of a case with CT and angiographic evaluation

A case of adrenal myelolipoma which was diagnosed preoperatively based on the combined examinations of computed tomography and angiography is presented. Computed tomography revealed a large suprarenal fatty tumor with increased density areas secondary to hemorrhage. Angiography demonstrated that the tumor originated from the adrenal gland.

Myelolipoma: an unusual surgical lesion of the adrenal gland

The clinical and pathologic features of three cases of surgically removed myelolipoma of the adrenal gland are presented. As with 18 previously reported cases, the lesions were found in obese, middle-aged persons; two of three had chronic, systemic disease (vasculitis and lymphoma, sustained hypertension). The only symptom possibly attributable to the neoplasm was nonspecific abdominal pain, and each lesion was identified by inferior renal displacement on intravenous urography. As computed tomography becomes widely available, the authors expect more myelolipomas to be detected that require surgical exploration, since there are no satisfactory, specific radiographic criteria to differentiate adrenal myelolipoma from adrenocortical carcinoma.

Adrenal myelolipoma simulating a retroperitoneal malignant neoplasm

We describe a case of a large myelolipoma (15 by 12 cm. maximum diameter) that was removed surgically and resembled clinically and semeiologically a malignant retroperitoneal tumor. The patient also had chronic pancreatitis and cholelithiasis. Experimental findings, as well as the frequent association of myelolipomas (usually small) with several chronic diseases, suggests that the adrenal myelolipoma is not a true neoplasm but, rather, a choristoma or, perhaps even more likely, a hyperplastic and/or metaplastic lesion.

Myelolipoma of the adrenal gland

We report the 14th case of myelolipoma of the adrenal gland. Recommendations for appropriate diagnostic and therapeutic methods are made. Myelolipoma of the adrenal gland is a rare non-functioning tumor composed of lipoid and hematopoietic elements. The most consistent complaint is abdominal pain caused by hemorrhage within the tumor. We identified an association with obesity and hypertension. Ultrasound combined with computed tomography is useful in diagnosis. With expanded use of these studies, myelolipoma will be recognized more frequently. Definitive diagnosis and treatment are accomplished by simple excision; radical surgery is unnecessary.

Myelolipoma of adrenal gland

Myelolipoma of the adrenal gland is a rare, benign tumor of which only 17 clinical cases have been reported previously in the literature. We document 1 additional case and review the pathogenesis of the tumor, with emphasis on the theory of the tissue necrosis as the major stimulus of the myelolipomatous changes in the adrenals.

Myelolipoma in a heterotopic adrenal gland: light and electron microscopic findings

A symptomatic myelolipoma of the heterotopic adrenal gland was diagnosed as the cause of nephrotic syndrome and was surgically removed. Remission of the nephrotic syndrome promptly ensued. Ultrastructurally, the tumor consisted of well-differentiated cells resembling adrenal cortical cells, bone marrow cells in various stages of differentiation, and lipid cells. Some cells that contained fat were of adrenal cortical origin, but the derivation of most lipid cells and of bone marrow elements could not be deduced from the present ultrastructural findings.

Ultrasonic spectrum of adrenal masses

Adrenal masses are amenable to ultrasonic examination. The ultrasonic characteristics of eight adrenal masses in 6 patients are described. In particular, an ultrasonic study of the natural history and progression of a large adrenal adenoma is reported. Adrenal masses on the right side may mimic right posterior liver masses on transverse scans alone. They may compress and displace the liver with expansion. Posterolateral impressions on the inferior vena cava occur. Differentiation from a superior pole renal mass is not always possible.