Computed tomography, sonographic, and radiographic findings in adrenal myelolipoma

Giant adrenal myelolipoma masquerading as heart failure

Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging. However, myelolipomas may insidiously grow to large sizes and cause mass effects and hemorrhage. Timely diagnosis and surgical resection are curative and lifesaving.

Clinicopathological Characteristics of Four Cases of Adrenal Myelolipomas: A Rare Surgical Entity

Myelolipomas are unusual benign tumors or tumor-like lesions, composed of hematopoietic cells and mature adipose tissue. They usually are asymptomatic and behave as non-functioning, unilateral, small adrenal tumors often found incidentally on imaging studies. We report the clinicopathological characteristics of four cases of adrenal myelolipomas treated in our hospital, worth to mention because of their rarity and their significant size. Myelolipomas were first described by Gierke in 1905, and the term myelolipoma was coined by Oberling in 1929. The adrenal gland is the most common site, but myelolipomas are also rarely present in extra-adrenal sites, including the pelvis, mediastinum, retroperitoneum, and paravertebral region, as an isolated soft tissue mass. These tumors account for 2.6% of the primary adrenal masses with equal sex distribution and in our reviewed material of a decade they constitute about 5% in a series of surgically treated adrenals for various neoplastic processes of the adrenals. Although usually small in size, in our series a remarkable large size of the tumors examined was observed, ranging from 7 - 15 cm. Adrenal myelolipoma is often an “incidentaloma”, since its diagnosis is frequently based on autoptic findings or made during surgical interventions and imaging procedures performed for other purposes, as happened in our cases.

Symptomatic giant adrenal myelolipoma associated with cholelithiasis: Two case reports

In this article, we have discussed about two cases of adrenal myelolipoma and aim to discuss the role of imaging in their diagnosis and their management. Different imaging techniques such as ultrasound, computed tomography and magnetic resonance imaging were used to aid in diagnosis in each of the cases. The findings have been highlighted here. In each of the cases, the diagnosis could be confirmed by imaging, and there was cholelithiasis seen associated with unilateral adrenal myelolipoma. Adrenal myelolipomas are rare, benign, non-functional tumors of adrenal gland. Most tumors are unilateral and small; bilateral, giant myelolipomas are extremely rare. The association of adrenal myelolipoma with gallstones is uncommon. To our knowledge only two cases of such an association have been reported in the literature. However, the possibility does exist and steps should be taken to ensure a complete diagnosis. Also, it is important to understand the key points which help us in diagnosing adrenal myelolipomas by imaging.

Myelolipoma of the adrenal gland associated with contralateral renal cell carcinoma: case report and review of the literature

Adrenal myelolipoma is a rare benign hormonally inactive tumor. It is frequently detected incidentally on new imaging procedures, such as sonography and computerized tomography and, thus, the question of treatment arises. The association of myelolipomas with obesity, hypertension and malignant tumors has been described previously. We report the second case of myelolipoma associated with renal cell carcinoma. Pathogenesis, differential diagnosis and therapy are discussed.

Natural history of an adrenal myelolipoma

Adrenal myelolipomas are rare, benign neoplasms composed of mature fat and bone marrow elements. Most are small, asymptomatic tumors found incidentally at postmortem examination. We report the natural history of an adrenal myelolipoma in a middle-aged woman during a 4-year interval.

Adrenal myelolipomas: CT appearance with tiny amounts of fat and punctate calcification

Five cases of myelolipoma of the adrenal are presented which contained only tiny foci of fat along with areas of punctate calcification. This computed tomographic (CT) appearance is less common for this neoplasm and has only been described in three of 26 previously published CT cases of this adrenal tumor. The presence of even tiny amounts of fat in an adrenal mass should alert the radiologist to the probable diagnosis of myelolipoma. Small foci of calcification are also frequently associated.

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: preoperative diagnosis by fine-needle aspiration cytology

Fine-needle aspiration (FNA) was performed under ultrasonographic guidance on a suprarenal mass in a 52-yr-old Japanese man. Preoperatively, the diagnosis of adrenal myelolipoma was easily established from the cytologic findings of the aspirates. FNA is a very useful technique for the differential diagnosis of this tumor, and it is particularly valuable for many hospitals that are not equipped with computed tomography.

Presacral myelolipoma

Extramedullary tumors of hematopoietic tissue can be divided into two categories: those associated with a bone marrow disorder, myelolipomas which have no apparent relation to a bone marrow disorder. The etiology of myelolipoma is unknown and the vast majority are adrenal in location. Extramedullary myelolipomas are usually presacral in location and none of the approximately ten reported cases has been diagnosed before surgery. Although radiographic and ultrasound features of myelolipomas are relatively characteristic, they are not specific and biopsy is required for diagnosis. Microscopic diagnosis requires demonstration of benign lipomatous tissue admixed with cellular hematopoietic tissue resembling normal bone marrow. This study reports a patient with presacral myelolipoma and an unusual finding of urinary retention and azotemia associated with compression of urinary bladder neck by the myelolipoma.

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 diagnosis by fine needle aspiration

We report 2 cases of adrenal myelolipoma. The diagnosis was suspected preoperatively in the first case on the basis of radiographic findings, ultrasonography and computerized tomography, and was confirmed by an operation. In the second case the diagnosis was established by fine needle biopsy. Computerized tomography and ultrasonography help in the preoperative diagnosis of myelolipoma but only fine needle biopsy can differentiate this lesion from a malignant neoplasm and avoid an operation.