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Laparoscopic adrenalectomy for a giant adrenal myelolipoma: A case report. Int J Surg Case Rep 2021; 90:106678. [PMID: 34952312 PMCID: PMC8715075 DOI: 10.1016/j.ijscr.2021.106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
CASE PRESENTATION We describe a case of a patient who presented with a mildly symptomatic, giant myelolipoma which was excised by laparoscopic approach without complications. INTRODUCTION AND IMPORTANCE Adrenal myelolipoma (AML) is a rare tumour composed by fat and myeloid tissues. Usually it is asymptomatic, so the diagnosis is mostly incidental. It is generally located in the right adrenal gland, but it can also be found bilaterally. If its size exceeds 10 cm it is defined as a "giant myelolipoma"; in this case its treatment of choice would be adrenalectomy with an open surgical approach. CLINICAL DISCUSSION Patient's signs and symptoms were mild pain in the right hypochondrium and a positive right Giordano's sign. The mass was detected by a contrast-enhanced CT scan. Once excised it measured 16 cm. CONCLUSION Laparoscopic adrenalectomy for giant myelolipoma is a safe approach if performed by an expert surgeon, with low risk of bleeding and a better outcome for the patient.
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Zhu GG, Witt BL, Winter III TC, Rogers DM. Multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. BMJ Case Rep 2021; 14:14/2/e239107. [PMID: 33622747 PMCID: PMC7907867 DOI: 10.1136/bcr-2020-239107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myelolipomas are benign tumours typically occurring in the adrenal glands, made up of fat and trilineage haematopoeitic cells resembling bone marrow. Their aetiology is not well understood; however, they have a clear association with elevated serum adrenocorticotropic hormone (ACTH). Extra-adrenal myelolipomas are rare, and to our knowledge there are no previously reported cases of multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. We present the case of a patient with an ACTH-producing pituitary adenoma who developed multiple enlarging fat containing lesions in the liver and retroperitoneum, which were histologically proven multifocal myelolipomas.
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Affiliation(s)
- Grace G Zhu
- Department of Radiology, University of Utah Health, Salt Lake City, UT, USA
| | - Benjamin L Witt
- Department of Anatomical Pathology, University of Utah Health, Salt Lake City, UT, USA
| | | | - Douglas M Rogers
- Department of Radiology, University of Utah Health, Salt Lake City, UT, USA
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Abstract
This paper describes a case of adrenal myelolipoma with an unusual characteristic: the presence of bone spicules. The lesion was associated with an accessory adrenal gland containing foci of myeloadiposis. The authors believe that myelolipoma and myeloadiposis are closely associated and are in fact the expression of a single process that is both focal (myeloadiposis) and diffuse (myelolipoma). The process consists of the differentiation of choristomatous primitive mesenchymal cells into hematopoietic tissue, adipose tissue and, in rare cases, bone tissue.
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Affiliation(s)
- A Rossi
- U.O. di Anatomia Patologica, Ospedale Misericordia, USL 9, Grosseto, Italy
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Park SY, Kwak MK, Kim HJ, Park HK, Suh KI, Yoo MH, Jin SY, Yun S, Byun DW. Case report of a bilateral adrenal myelolipoma associated with Cushing disease. Medicine (Baltimore) 2017; 96:e9455. [PMID: 29384929 PMCID: PMC6392800 DOI: 10.1097/md.0000000000009455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Adrenal myelolipomas are rare benign tumors, composed of a variable mixture of mature adipose tissue and hematopoietic tissue. These tumors are frequently detected incidentally and are usually asymptomatic, and hormonally inactive. PATIENT CONCERNS During a routine health checkup, a 52-year-old man was found to have a tumor on the bilateral adrenal glands. Abdominal computed tomography revealed a well-defined, heterogeneously enhanced bilateral adrenal mass, suggesting a myelolipoma. DIAGNOSES The hormonal evaluation revealed adrenocorticotropic hormone (ACTH) dependent Cushing syndrome. INTERVENTIONS The patient underwent left adrenalectomy, and transsphenoidal resection of a pituitary mass. The final diagnosis was adrenal myelolipoma associated with Cushing disease. OUTCOMES Growth of right adrenal myelolipoma was detected during the 7-year follow-up. There were enhancing pituitary lesions in repeat magnetic resonance imaging of the sellar region, which implies persistent or recurrent pituitary adenoma. This case reinforces relationship between Cushing disease and adrenal myelolipoma. LESSONS To the best of our knowledge, this is the first reported pathologically confirmed bilateral adrenal myelolipoma associated with Cushing disease. This report supports the idea that ACTH is associated with the development of adrenal myelolipoma.
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Affiliation(s)
- Se Yoon Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Kyo-Il Suh
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Myung Hi Yoo
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - So Young Jin
- Departments of Pathology, Soon Chun Hyang University College of Medicine
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
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Jeon HJ, Lee SY. A CASE OF ADRENAL MYELOLIPOMA A PATIENT WITH BREAST CANCER. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:90-95. [PMID: 31149154 DOI: 10.4183/aeb.2017.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Adrenal myelolipoma is a rare benign tumor composed of adipose tissue and hematopoetic elements resembling bone marrow. The majority of myelolipoma do not produce adrenal hormones and are only found as a result of evaluation for another disorder. With the widespread use of non-invasive abdominal imaging for various reason, its incidental detection has become more common. There are a few cases of breast cancer with concomitant adrenal myelolipoma in the literature. Case A 43-year-old woman presented to endocrine clinic due to presurgical assessment of adrenal mass prior breast cancer surgery. Abdominal CT showed a 9 x 8 cm sized, lobulated contour heterogeneous fatty density mass with peripheral calcification in right adrenal gland. Hormonal studies for adrenal incidentaloma revealed: Aldosterone/Renin ratio, 0.70 ([normal range < 30]; normal DHEA-S, 85.0 µg/dL ([normal range, 80 -560 µg/dL]), ACTH 25 pg/mL ([normal range, 10 - 60 pg/mL]), morning serum cortisol 8.9 µg/dL ([normal range, 5 - 12 µg/dL]). In 24-hour urine, there revealed free cortisol 21.6 µg/day ([normal range, 10 - 50 µg/day); metanephrine 0.19 mg/day ([normal range < 0.8 mg/day]); 17-ketosteroid 14.06 mg/day ([normal range, 7 - 20 mg/day]). The hormonal results of adrenal mass revealed as nonfunctioning. The adrenal mass was surgically resected in order to rule out malignancy. Pathology report showed myelolipoma. Conclusion We reported a case of adrenal myelolipoma coexisting with breast cancer where the diagnosis was made incidentally based on radiological features, treated with surgical resection.
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Affiliation(s)
- H J Jeon
- Chunbguk National University, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| | - S Y Lee
- Hankook General Hospital, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
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6
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Caliumi C, De Toma G, Bossini A, Cianci R, Bosman C, Genuardi M, Cerci S, Letizia C. A rare combination consisting of aldosterone-producing adenoma and adrenal myelolipoma in a patient with heterozygosity for retinoblastoma (RB) gene. J Renin Angiotensin Aldosterone Syst 2016; 5:45-8. [PMID: 15136974 DOI: 10.3317/jraas.2004.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Various pathological disorders have been associated with primary aldosteronism, including glucagonoma, phaeochromocytoma and primary hyperparathyroidism. In this report, a case of adrenal myelolipoma (a rare non-functioning tumour composed of mature adipose tissue and normal haematopoietic elements similar to bone marrow cells), aldosterone-producing adenoma and a pituitary microadenoma coexisting in a 62-year-old man with a 15-year history of arterial hypertension, previous ablation of an autonomously-functioning thyroid adenoma, multiple lipomas and an heterozygosity of the retinoblastoma (RB) susceptibility gene is reported. We believe that this case probably represents another variant of the multiple neoplasia syndrome and we speculate that structural alteration of the RB gene may play a role in the tumorogenesis.
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Affiliation(s)
- Chiara Caliumi
- Department of Clinical Science, University of Rome La Sapienza, Rome, Italy
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Chakraborty PP, Bhattacharjee R, Mukhopadhyay P, Chowdhury S. Bilateral adrenal myelolipoma in Cushing's disease: a relook into the role of corticotropin in adrenal tumourigenesis. BMJ Case Rep 2016; 2016:bcr-2016-214965. [PMID: 27307426 DOI: 10.1136/bcr-2016-214965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal myelolipomas are infrequently encountered benign tumours of unknown aetiology. In the majority of cases they are unilateral, and clinically and hormonally silent, only requiring periodic follow-up. However, bilateral adrenal myelolipomas are sometimes associated with endocrine disorders and warrant appropriate evaluation. Though the understanding of the pathophysiology of adrenal myelolipomas has long been elusive, adrenocorticotropic hormone (ACTH) has been proposed as the main tropic factor in a number of studies. Cushing's disease is rarely associated with bilateral and sometimes giant myelolipomas. In this article, the association of bilateral adrenal myelolipomas with Cushing's disease has been discussed and the role of ACTH in the tumourigenesis has been reviewed.
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Affiliation(s)
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
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8
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Sajjanar AB, Athanikar VS, Dinesh US, Nanjappa B, Patil PB. Non Functional Unilateral Adrenal Myelolipoma, A Case Report. J Clin Diagn Res 2015; 9:ED03-4. [PMID: 26266130 PMCID: PMC4525519 DOI: 10.7860/jcdr/2015/13209.6070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/09/2015] [Indexed: 11/24/2022]
Abstract
Adrenal myelolipoma is characterized by presence within the adrenal gland of mature adipose tissue and active bone marrow elements. Owing to their non functional nature most cases are incidental, either at autopsy or through computer tomography scan. Occasionally the lesions attain a large size to become clinically apparent. We present a case of a 58-year-old female with mass per abdomen. Preoperative computer tomography scan of abdomen, hormonal and urine analysis showed features of non functional adrenal myelolipoma. Gross specimen consists of unilateral ovoid mass, external surface having capsule with adherent fat and areas of congestion. Microscopic examination showed well encapsulated tumour tissue composed of mature adipose tissue with major blood forming elements like myeloid, erythroid and megakaryocytic series. The diagnosis was confirmed by histopathological examination of right sided adrenalectomy specimen.
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Affiliation(s)
- Anita B Sajjanar
- Assistant Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Vidisha S. Athanikar
- Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - U S Dinesh
- Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Bhuvnesh Nanjappa
- Associate Professor, Department of Urology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Preetam B. Patil
- Associate Professor, Department of Urology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
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Corpas Jiménez MS, Ortega Salas R, Tenorio Jiménez C, Molina Puerta MJ. Mielolipoma asociado a adenoma adrenocortical: una causa infrecuente de síndrome de Cushing. ACTA ACUST UNITED AC 2014; 61:e7-9. [DOI: 10.1016/j.endonu.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/26/2022]
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10
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Yamada S, Tanimoto A, Wang KY, Ding Y, Guo X, Shimajiri S, Sasano H, Sasaguri Y. Non-functional adrenocortical adenoma: A unique case of combination with myelolipoma and endothelial cysts. Pathol Res Pract 2011; 207:192-6. [PMID: 20846791 DOI: 10.1016/j.prp.2010.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
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Olivar Roldán J, Molina Baena B, Pavón de Paz I, Iglesias Bolaños P, Montoya Álvarez T, Fernández Martínez A. Giant adrenal myelolipoma: case report and literature review. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2008; 55:139-141. [PMID: 22967880 DOI: 10.1016/s1575-0922(08)70650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 09/15/2007] [Indexed: 06/01/2023]
Abstract
Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma and provide a review of the literature.
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Affiliation(s)
- Juana Olivar Roldán
- Servicio De Endocrinología Y Nutrición. Hospital Universitario De Getafe. Getafe. Madrid. España
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Hagiwara H, Usui T, Kimura T, Tagami T, Naruse M, Minamiguchi S, Kato T, Okuno H, Shimatsu A. Lack of ACTH and androgen receptor expression in a giant adrenal myelolipoma associated with 21-hydroxylase deficiency. Endocr Pathol 2008; 19:122-7. [PMID: 18618087 DOI: 10.1007/s12022-008-9034-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Myelolipomas of the adrenal gland are benign, nonfunctioning tumors. Patients with congenital adrenal hyperplasia sometimes develop large and bilateral myelolipomas. Although the precise pathogenesis of myelolipomas remains unclear, prolonged stimulation with high levels of adrenocorticotropic hormone (ACTH) or adrenal androgens are assumed to have a causative role. To clarify the role of ACTH and androgen in the pathogenesis of myelolipoma, we report a case of giant adrenal myelolipoma in a patient with poorly controlled congenital adrenal hyperplasia. A 43-year-old female was diagnosed with congenital adrenal hyperplasia at 6 years of age because of ambiguous genitalia. She had high plasma ACTH and 17-hydroxyprogesterone levels. Abdominal computed tomography showed a huge mass on the left adrenal gland, and an enlarged right adrenal mass. Genetic testing for CYP21A2 was performed and revealed that her genotype was IVS2-13A/C>G/I172N. Adrenalectomy for the left-side tumor was performed. Histological study revealed that the tumor consisted of fat cells and myeloid components, findings compatible with adrenal myelolipoma. Neither ACTH receptors nor androgen receptor was over-expressed in the tumor. Our finding that the tumor did not over-express ACTH or androgen receptor suggests a limited direct role for these hormones in the development of the myelolipoma.
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Affiliation(s)
- Hanae Hagiwara
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Patocs A, Liko I, Varga I, Gergics P, Boros A, Futo L, Kun I, Bertalan R, Toth S, Pazmany T, Toth M, Szücs N, Horanyi J, Glaz E, Racz K. Novel mutation of the CYP17 gene in two unrelated patients with combined 17alpha-hydroxylase/17,20-lyase deficiency: demonstration of absent enzyme activity by expressing the mutant CYP17 gene and by three-dimensional modeling. J Steroid Biochem Mol Biol 2005; 97:257-65. [PMID: 16176874 DOI: 10.1016/j.jsbmb.2005.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 06/01/2005] [Indexed: 10/25/2022]
Abstract
The CYP17 gene, located on chromosome 10q24-q25, encodes the cytochrome P450c17 enzyme. Mutations of this gene cause the 17alpha-hydroxylase/17,20-lyase deficiency, which is a rare, autosomal recessive form of congenital adrenal hyperplasia. Approximately 50 different mutations of the CYP17 gene have been described, of which some mutations have been identified in certain ethnic groups. In this study, we present the clinical history, hormonal findings and mutational analysis of two patients from unrelated families, who were evaluated for hypertension, hypokalemia and sexual infantilism. In the first patient, who was a 37-year-old female, additional studies showed a large myelolipoma in the left adrenal gland, and a smaller tumor in the right adrenal gland. In the second patient, who was a 31-year-old phenotypic female, clinical work-up revealed a 46,XY kariotype, absence of ovaries and presence of testes located in the inner opening of both inguinal canals. Analysis of the CYP17 gene by polymerase chain reaction amplification and direct sequencing demonstrated a novel homozygous mutation of codon 440 from CGC (Arg) to TGC (Cys) in both patients. The effect of this novel mutation on 17alpha-hydroxylase/17,20-lyase activity was assessed by in vitro studies on the mutant and wild-type P450c17 generated by site-directed mutagenesis and transfected in nonsteroidogenic COS-1 cells. These studies showed that the mutant P450c17 protein was produced in transfected COS-1 cells, but it had negligible 17alpha-hydroxylase and 17,20-lyase activities. In addition, three-dimensional computerized modeling of the heme-binding site of the P450c17 enzyme indicated that replacement of Arg by Cys at amino acid position 440 predicts a loss of the catalytic activity of the enzyme, as the mutant enzyme containing Cys440 fails to form a hydrogen bond with the propionate group of heme, which renders the mutant enzyme unable to stabilize the proper position of heme. Based on these findings we conclude that expressing the CYP17 gene with functional analysis, combined with three-dimensional computerized modeling of the heme-binding site of the protein provide feasible tools for molecular characterizing of functional consequences of the novel CYP17 mutation on enzyme function.
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Affiliation(s)
- Attila Patocs
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Szentkirályi, Hungary
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Matsuda T, Abe H, Takase M, Arakawa A, Matsumoto T, Fujime M, Suda K. Case of combined adrenal cortical adenoma and myelolipoma. Pathol Int 2004; 54:725-9. [PMID: 15363042 DOI: 10.1111/j.1440-1827.2004.01686.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of myelolipoma 10 mm in size within a functional cortical adenoma that was 33 x 22 x 17 mm in size. A 29-year-old woman was referred to hospital for transient hypertension. A right adrenal tumor was detected by computed tomography (CT) scan and magnetic resonance imaging (MRI). Her cortisol levels indicated a loss of the normal diurnal pattern, and urinary 17-hydroxycorticosteroids was elevated. She underwent a right adrenalectomy under the diagnosis of adrenal adenoma with Cushing's syndrome. The tumor was fairly well encapsulated by a thin layer of connective tissue. The major tumor portion was composed of two distinct cell types, clear cells and eosinophilic cells, arranged in an alveolar structure. These findings were representative of cortical adenoma. The adrenal cortical adenoma centrally included well-demarcated adipose tissue admixed with scattered islands of myelopoietic elements: erythroblasts, myeloid cell series and lymphocytic cells, which was eventually recognized as myelolipoma. Recently, adrenal myelolipoma has commonly been found because of the ease of detecting it as an incidentaloma by CT scan or MRI. However, the present adrenal myelolipoma case is uncommon because it is combined with a functioning cortical adenoma. Only six similar cases have previously been reported in English and Japanese publications. Furthermore, in the present case, the myelolipoma formed a tumor nodule, and to our knowledge, this is the first reported case of a radiographically recognizable tumor nodule. We discuss the etiology of myelolipoma and suggest that myelolipoma can develop in the course of endocrine hyperfunction.
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Affiliation(s)
- Takaharu Matsuda
- Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
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Chang KC, Chen PI, Huang ZH, Lin YM, Kuo PL. Adrenal myelolipoma with translocation (3;21)(q25;p11). CANCER GENETICS AND CYTOGENETICS 2002; 134:77-80. [PMID: 11996801 DOI: 10.1016/s0165-4608(01)00592-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adrenal myelolipoma (ML) is a rare, benign, nonfunctioning tumor-like lesion composed of mature adipose tissue interspersed with bone marrow-like hematopoietic elements in various proportions. It occurs usually in adults and is frequently asymptomatic in about half of cases. The histogenesis of adrenal ML is not clear and this lesion has been found to be associated with endocrine disorders, other adrenal dysfunction and tumors, and hyperstimulation with adrenocorticotropic hormone. Specific chromosomal abnormalities, however, have not been observed in such cases. Herein, we report a typical case of adrenal ML found incidentally in a 26-year-old man. Conventional cytogenetic techniques demonstrated balanced translocation between bands 3q25 and 21p11 in 9 of 20 metaphases analyzed in cultured tumor cells. To the best of our knowledge, this is the first reported case of adrenal ML showing chromosomal abnormality. This finding would indicate that adrenal ML is a bona fide neoplasm and the possibility of derivation from misplaced hematopoietic cells may be alternatively taken into consideration in view of the similar genetic changes in hematopolietic neoplasms.
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Affiliation(s)
- Kong Chao Chang
- Department of Pathology, National Chen Kung University Medical Center, 138 Sheng-Li Road, Tainan, Taiwan 70428
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Abstract
Authors present a case of giant adrenal myelolipoma, where the tumor was hormonally inactive but caused abdominal and flank pain. The huge tumor, a 20x18x10 cm mass, was surgically removed. The ipsilateral kidney was preserved.
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Affiliation(s)
- D L Répássy
- Saint Stephen Hospital, Department of Urology, Budapest, Nagyvárad tér 1., H-1096, Hungary
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Juarez D, Brown RW, Ostrowski M, Reardon MJ, Lechago J, Truong LD. Pheochromocytoma associated with neuroendocrine carcinoma. A new type of composite pheochromocytoma. Arch Pathol Lab Med 1999; 123:1274-9. [PMID: 10583935 DOI: 10.5858/1999-123-1274-pawnc] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The coexistence of pheochromocytoma and other tumor types in a single adrenal gland has been rarely documented. This type of pheochromocytoma is designated "composite" or "mixed," depending on whether the pheochromocytoma and the nonpheochromocytoma components show the same embryologic origin. The nonpheochromocytoma components reported in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The components found in the mixed pheochromocytoma include adrenal cortical neoplasms and spindle cell sarcoma. We report a unique case of composite pheochromocytoma in which the nonpheochromocytoma element is a neuroendocrine carcinoma. The histologic and the immunohistochemical profiles of the 2 distinct components of this tumor were typical for those of pheochromocytoma and neuroendocrine carcinoma. This dual differentiation was also supported by ultrastructural findings. This case not only broadens the morphologic spectrum of composite pheochromocytoma but also provides some additional insight into the histogenesis of this rare but fascinating type of tumor.
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Affiliation(s)
- D Juarez
- Department of Pathology, Baylor College of Medicine, and The Methodist Hospital, Houston, TX 77030, USA
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Settakorn J, Sirivanichai C, Rangdaeng S, Chaiwun B. Fine-needle aspiration cytology of adrenal myelolipoma: case report and review of the literature. Diagn Cytopathol 1999; 21:409-12. [PMID: 10572274 DOI: 10.1002/(sici)1097-0339(199912)21:6<409::aid-dc9>3.0.co;2-a] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adrenal myelolipoma is a rare nonfunctioning tumor consisting histologically of an admixture of adipose tissue and extramedullary hemopoietic elements within the adrenal glands. Less than 300 cases have been reported in the literature and only 15 case reports have described cytological findings of this tumor obtained by fine-needle aspiration (FNA). We report a case of a 48-year-old male who had had anaplastic large cell carcinoma of the right lung. The left adrenal mass was encountered during a staging workup that led to a clinical suspicion of metastatic disease to the adrenal gland. FNA under computed tomography (CT) guidance was performed obtaining cytological material from which diagnosis of myelolipoma was made. The findings reemphasized an important role of FNA in investigation of adrenal mass. The literature on FNA cytology of adrenal myelolipoma is reviewed. Diagn. Cytopathol. 1999;21:409-412.
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Affiliation(s)
- J Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Adesokan A, Adegboyega PA, Cowan DF, Kocurek J, Neal DE. Testicular "tumor" of the adrenogenital syndrome: a case report of an unusual association with myelolipoma and seminoma in cryptorchidism. Cancer 1997; 80:2120-7. [PMID: 9392334 DOI: 10.1002/(sici)1097-0142(19971201)80:11<2120::aid-cncr11>3.0.co;2-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Males with congenital adrenal hyperplasia may develop bilateral testicular masses in early adult life. These are not malignant and generally regress with corticosteroid therapy. The authors report a case occurring in a 44-year-old man with associated seminoma and myelolipoma in an undescended testis. METHODS The testicular tumors were analyzed by histologic, flow cytometric, and ultrastructural techniques. RESULTS The tumors in both testes were comprised of polygonal cells with abundant granular eosinophilic cytoplasm, occasionally with brown (lipochrome) pigment and round nuclei of various sizes with prominent nucleoli. These cells were grouped into nodules by dense and sometimes thick fibrous trabeculae in the right testis. The areas corresponding to the fibrous trabeculae in the left (intraabdominal) testis were replaced by mixture of hematopoietic (myeloid) and fatty tissue in various proportions characteristic of myelolipoma. The left testis also had a well demarcated tumor that was diagnostic of seminoma. Electron microscopy demonstrated abundant smooth endoplasmic reticulum, a moderate number of mitochondria with tubulovesicular cristae, lipid droplets, and lipofuscin granules in the polygonal cells. No Reinke's crystals were observed. The patient received corticosteroids for his adrenocorticoid deficiency and also underwent external beam irradiation to the retroperitoneum for seminoma. CONCLUSIONS This case illustrates an unusual presentation of a testicular tumor in a patient with the adrenogenital syndrome as well as with myelolipoma and seminoma in a cryptorchid testis. The possibility of an associated neoplasm that could be potentially fatal should be considered whenever a testicular tumor of the adrenogenital syndrome continues to grow despite adequate hormonal treatment.
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Affiliation(s)
- A Adesokan
- Department of Pathology, The University of Texas Medical Branch, Galveston 77555-0588, USA
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21
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Umpierrez MB, Fackler S, Umpierrez GE, Rubin J. Adrenal Myelolipoma Associated With Endocrine Dysfunction: Review of the Literature. Am J Med Sci 1997. [DOI: 10.1016/s0002-9629(15)40233-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Umpierrez MB, Fackler S, Umpierrez GE, Rubin J. Adrenal myelolipoma associated with endocrine dysfunction: review of the literature. Am J Med Sci 1997; 314:338-41. [PMID: 9365337 DOI: 10.1097/00000441-199711000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of bilateral adrenal myelolipoma in association with congenital adrenal hyperplasia caused by 21-hydroxylase deficiency is presented. The clinical, radiologic, and endocrinologic features of this case are correlated with a review of the literature.
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Affiliation(s)
- M B Umpierrez
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
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23
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Abstract
Adrenal myelolipomas are usually small and asymptomatic tumors discovered incidentally. In a small number of cases, acute pain may develop secondary to intratumoral and/or retroperitoneal bleeding. We observed a large, surgically and histologically confirmed, myelolipoma of the right adrenal gland with spontaneous internal and external hemorrhage. CT demonstrated heterogeneity of the mass, obliteration of the surrounding fat planes, and retroperitoneal blood dissection. A literature review produced only 5 reports of ruptured myelolipoma with external hemorrhage.
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Affiliation(s)
- O Catalano
- Department of Radiology, University Federico II, Naples, Italy
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24
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Papotti M, Sapino A, Mazza E, Sandrucci S, Volante M, Bussolati G. Lipomatous Changes in Adrenocortical Adenomas: Report of Two Cases. Endocr Pathol 1996; 7:223-228. [PMID: 12114735 DOI: 10.1007/bf02739925] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rare cases of myelolipomas associated with adrenocortical lesions responsible for Cushing or Conn syndromes have been described. We report two additional cases of extensive lipomatous changes in incidentally discovered adrenocortical adenomas, which were preoperatively interpreted as myelolipomas on the basis of radiologic findings. Microscopically, the adenomas were composed of sheets and nests of adrenocortical cells, and extensive areas of mature adipose tissue admixed with a bland stromal infiltration of small cells. The impression was that myeloid cells were present, featuring a myelolipoma associated with a clear cell adenoma of the adrenal cortex, but specific immunocytochemical markers of myeloid lineage were not reactive in the small cell component, and these cells consisted of small lymphocytes. The lipomatous tissue may represent a degenerative phenomena within an adrenocortical adenoma or may be an additional neoplastic component of the tumor. Irrespective of their origin, extensive (myelo)lipomatous changes in adrenocortical tumors can lead to misinterpretations in the preoperative work-up of patients with adrenal masses.
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25
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Feldberg E, Guy M, Eisenkraft S, Czernobilsky B. Adrenal cortical adenoma with extensive fat cell metaplasia. Pathol Res Pract 1996; 192:62-5; discussion 66. [PMID: 8685043 DOI: 10.1016/s0344-0338(96)80132-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This report describes a large adrenal cortical tumor with a significant component of mature adipose tissue in a 40 year old woman. No bone marrow elements were identified in multiple sections. This lesion, representing most likely an adrenal cortical adenoma with extensive fat cell metaplasia, has not been previously reported and must be differentiated from adrenal myelolipoma.
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Affiliation(s)
- E Feldberg
- Department of Pathology, Kaplan Hospital, Rehovot, Israel
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26
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Jenkins PJ, Chew SL, Lowe DG, Reznek RH, Wass JA. Adrenocorticotrophin-independent unilateral macronodular adrenal hyperplasia occurring with myelolipoma: an unusual cause of Cushing's syndrome. Clin Endocrinol (Oxf) 1994; 41:827-30. [PMID: 7889621 DOI: 10.1111/j.1365-2265.1994.tb02800.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P J Jenkins
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
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27
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Hirakawa E, Haba R, Miki H, Kobayashi S, Ishikawa M, Mori S, Ohmori M, Sugimoto M. Giant symptomatic myelolipoma of the adrenal gland. Pathol Int 1994; 44:800-2. [PMID: 7834082 DOI: 10.1111/j.1440-1827.1994.tb02929.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of giant symptomatic myelolipoma is described in which clinical differentiation was difficult. It was considered to be an extremely rare case of giant myelolipoma arising in the adrenal gland. Histologically the present case contained more lipomatous elements than others reported to data. This is a case of giant adrenal myelolipoma with a few foci of myeloid elements and it is suggested that this case has a true neoplastic nature rather than a hyperplastic or metaplastic one.
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Affiliation(s)
- E Hirakawa
- Department of Pathology, Kagawa Medical School, Japan
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28
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Ito T, Asano K, Nomura K, Hori M, Wakui S, Kikuchi Y, Akiyama A, Furusato M, Aizawa S. Two cases of adrenal myelolipoma. ACTA PATHOLOGICA JAPONICA 1992; 42:221-6. [PMID: 1570744 DOI: 10.1111/j.1440-1827.1992.tb01675.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report myelolipoma found in two patients, of whom one had hormonal abnormalities related to adrenal function. The first patient was a 36-year-old woman, who was found incidentally to have a left adrenal tumor by CT scan during admission for treatment of Guillain-Barré syndrome. Obesity, hirsutism and osteoporosis were also evident, and the patient was forwarded for additional endocrine function analysis, which revealed elevation of serum cortisol, urine 17-OHCS and 17-KS, and a decreased level of ACTH. These abnormalities returned to normal after excision of the tumor. Pathologically, the tumor was composed of mature fat cells and hematopoietic components, and was diagnosed as myelolipoma. The second patient was a 63-year-old woman, who was receiving follow-up care for hyperthyroidism. A right adrenal tumor was noted incidentally in a routine examination by CT scan. Endocrinologically, she was found to have no abnormalities of adrenal function. The tumor was excised, and diagnosed pathologically as myelolipoma, being composed of mature fat cells and hematopoietic components. Generally, although most myelolipomas have no endocrine function, our first patient showed features of Cushing's syndrome. Thus it is suggested that an interrelationship may exist between myelolipoma and endocrinological alteration.
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Affiliation(s)
- T Ito
- Department of Pathology, Jikei University, School of Medicine, Tokyo, Japan
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29
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Nirchio V, Fulcheri E. Mielolipoma Della Surrenale. Urologia 1991. [DOI: 10.1177/039156039105800414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Jermendy G, Szabolcs I, Szilágyi G, Dömötör L, Kárpáti P. Diabetes mellitus associated with late onset congenital adrenal hyperplasia: coincidence or causality? Diabet Med 1991; 8:489-91. [PMID: 1830536 DOI: 10.1111/j.1464-5491.1991.tb01637.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes mellitus and late onset congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency were observed in two female siblings aged 51 and 60 years. Not only coincidence but also causality (hyperinsulinism, glucose intolerance due to hyperandrogenism) should be considered when explaining the association of diabetes mellitus with late onset congenital adrenal hyperplasia.
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Affiliation(s)
- G Jermendy
- Medical Department of Merényi Hospital, Budapest, Hungary
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31
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Tanaka T, Matsuo N, Ishikura H, Takagi D, Takeyama N. Adrenal myelolipoma: a case report and review of the literature. THE JAPANESE JOURNAL OF SURGERY 1989; 19:597-606. [PMID: 2687530 DOI: 10.1007/bf02471670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- T Tanaka
- Emergency Care Unit Kansai Medical University, Osaka, Japan
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32
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Fonseca E, Sobrinho-Simões M. Letter to the Case. Pathol Res Pract 1989. [DOI: 10.1016/s0344-0338(89)80173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 46-1988. A 59-year-old man with angina pectoris, variable hypertension, and an adrenal mass. N Engl J Med 1988; 319:1336-43. [PMID: 3185636 DOI: 10.1056/nejm198811173192007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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34
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Neumann MP, Manivel C, Dehner LP. Adrenal myelolipoma: fine-needle aspiration of an asymptomatic retroperitoneal mass. Diagn Cytopathol 1987; 3:82-4. [PMID: 3568977 DOI: 10.1002/dc.2840030116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We report a case of myelolipoma of the adrenal gland diagnosed by ultrasound-guided fine-needle aspiration in a patient with bronchogenic carcinoma who was noted to have a 5-cm adrenal mass on computerized tomography during evaluation for metastatic disease. The cytologic features are characteristic and consist of mature adipocytes and bone marrow elements that are most clearly demonstrated on Wright-stained cytospin material. This case illustrates the importance of fine-needle aspiration in the evaluation of radiologically detected adrenal masses in patients with known malignancies. A cytologic diagnosis of benign or metastatic disease can eliminate the need for formal surgical exploration in selected cases.
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35
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Dieckmann KP, Hamm B, Pickartz H, Jonas D, Bauer HW. Adrenal myelolipoma: clinical, radiologic, and histologic features. Urology 1987; 29:1-8. [PMID: 3541345 DOI: 10.1016/0090-4295(87)90587-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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.
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36
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Abstract
A case of adrenal myelolipoma, to the authors' knowledge, the first diagnosed by fine-needle aspiration, is reported. Adrenal myelolipoma is an unusual, benign lesion with a distinctive cytologic appearance. Computed tomography (CT)-guided fine-needle aspiration of the adrenal gland involves minimal morbidity and provides rapid, reliable differentiation of this entity from a malignant neoplasm.
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