Presacral myelolipoma: case report with computed tomographic and angiographic findings

Meta-analysis of reported presacral myelolipomas, including a report of a new case

BACKGROUND

Presacral myelolipomas form a rare disease and are often found incidentally in imaging diagnostics.

CASE PRESENTATION

In this study, we report the case of a 71-year-old caucasian female with an incidental finding of a retroperitoneal tumor on magnetic resonance imaging scan. This report aimed at presenting the clinical course of this patient with emphasis on analysis of pathological, clinical, and epidemiological features in a meta-analysis of reported cases.

CONCLUSION

Presacral myelolipomas are rare and its etiology remains unclear. Surgical resection is indicated in symptomatic lesions and lesions > 4 cm. More clinical and pathological research on this rare entity is warranted.

Retroperitoneal extra-adrenal myelolipoma misdiagnosed as liposarcoma: A case report

Myelolipomas are rare benign tumors that contain a mix of fatty and hematopoietic tissues. These tumors are frequently seen in the adrenal glands. While extra-adrenal myelolipomas are extremely rare, once identified, they are commonly found in the retroperitoneum––particularly the presacral region. Because of the fat content, these tumors can be easily mistaken for retroperitoneal liposarcomas. We are presenting a case of a 44-year-old female with a pathology proven case of retroperitoneal extra-adrenal myelolipoma that was initially diagnosed by imaging as a retroperitoneal liposarcoma. In this case report, the clinical presentation, imaging findings, operative details and histopathology features are illustrated.

Presacral myelolipoma, case report and literature review

INTRODUCTION

Myelolipomas are very rare benign tumours consisting of hematopoietic cells and mature adipose tissues. They are most commonly found in the adrenal glands. However, there have been several reported cases of extra-adrenal myelolipomas, most commonly in the presacral region. Nearly all presacral lesions are small and asymptomatic; thus, most are discovered incidentally on imaging studies.

PRESENTATION OF CASE

We report two cases of presacral myelolipomas. The first is a 48-year-old female presenting with atypical back pain, found to have a mass in her presacral region with a size of 3,3 cm. The second case is a 59-year-old female, who presented for evaluation of a hip fracture, found to have a 4,7 cm presacral lesion. Both presacral myelolipomas were discovered incidentally and were confirmed by percutaneous guided fine-needle aspiration biopsy. Both were treated conservatively.

DISCUSSION

Accepted indications for the surgical excision of myelolipomas are symptomatic tumour, size >4 cm, metabolically active tumour, and a suspicion of malignancy on an imaging study. However, previous reports have documented that nearly half of the conservatively managed myelolipomas with a mean initial size of 5,1 cm, has increased in size or became symptomatic over a 3-years period.

CONCLUSION

We conclude that symptomatic presacral myelolipomas or lesions larger than 4 cm should be en-bloc resected, and we present an intuitive decision-making algorithm.

Giant Presacral Myelolipoma

Myelolipomas are benign tumors composed of hematopoietic tissue and mature fatty tissue and occur primarily in the adrenal glands. Extra-adrenal sites for these tumors are rare. To date 37 cases have been reported in the literature with more than half of these lesions being presacral in location. The purpose of this report is to raise awareness of this unusual tumor when formulating a differential diagnosis for retroperitoneal tumors. Presacral myelolipomas are easily confused with both primary and secondary malignant retroperitoneal tumors, which are far more common and aggressive neoplasms. Particular radiographic and histologic qualities distinguish this tumor from invasive malignancy. A case report is presented with a review of the literature on extra-adrenal myelolipomas.

[Presacral myelolipoma]

Presacral myelolipoma is a rare benign tumour of unknown aetiology, composed of mature adipose tissue with intermixed normal haematopoietic cells. Computed tomography is of help in the diagnosis but biopsy is mandatory in order to avoid unnecessary surgery. A case is reported.

Presacral myelolipoma: sonographic appearance

We describe an uncommon case of presacral myelolipoma in a 11/2-year-old boy, causing urinary retention and constipation. The sonographic appearance of the mass mimics a "pseudoprostatic enlargement".