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Rezaee H, Tavallaii A, Keykhosravi E, Abouei Mehrizi MA, Safdari Z, Pishjoo M, Aminzadeh B, Alenabi A. Spinal myelolipoma - an extremely rare pathology within the lumbar spine: a case report and literature review. Br J Neurosurg 2023; 37:1805-1808. [PMID: 34027765 DOI: 10.1080/02688697.2021.1926923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Myelolipoma is a benign tumor containing mature adipose cells and a combination of myeloid and erythroid elements. This tumor is typically found in the adrenal glands; however, it has been detected outside the adrenal glands in rare cases. We report an extremely rare case of myelolipoma in the lumbar spine causing significant neural compression due to the involvement of the posterior spinal elements. Given the significant neurological deficit, the patient was surgically managed as soon as possible. Extra-adrenal myelolipomas are rare lesions, and only one case has been reported in the spine so far. However, this diagnosis should be considered in cases with its characteristic imaging features.
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Affiliation(s)
- Hamid Rezaee
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Tavallaii
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zohre Safdari
- Department of Radiology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Masoud Pishjoo
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Anita Alenabi
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran
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Shimoda H, Kijima T, Takada-Owada A, Ishida K, Kamai T. A case of perirenal extra-adrenal myelolipoma mimicking liposarcoma. Urol Case Rep 2023; 50:102523. [PMID: 37664534 PMCID: PMC10468332 DOI: 10.1016/j.eucr.2023.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
Myelolipoma is a benign tumor composed of mature adipose tissue and normal hematopoietic components. It usually occurs in the adrenal glands but rarely in the extra-adrenal region. However, it is difficult to differentiate extra-adrenal myelolipoma from well-differentiated liposarcoma on the basis of the radiological findings. We report the case of a 66-year-old male with perirenal and extra-adrenal myelolipoma who underwent radical tumor resection with nephrectomy after a preoperative diagnosis of liposarcoma. Intraoperative assessment by the surgeon and intraoperative pathological evaluation are important considering the divergent prognoses of myelolipoma and liposarcoma.
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Affiliation(s)
- Hiroki Shimoda
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Toshiki Kijima
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Atsuko Takada-Owada
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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3
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Xu C, Kasajima A, Novotny A, Friess H. Meta-analysis of reported presacral myelolipomas, including a report of a new case. J Med Case Rep 2023; 17:31. [PMID: 36721209 PMCID: PMC9890845 DOI: 10.1186/s13256-022-03746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/27/2022] [Indexed: 02/02/2023] Open
Abstract
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.
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Affiliation(s)
- Congde Xu
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Atsuko Kasajima
- grid.6936.a0000000123222966Klinikum rechts der Isar, Institut für Allgemeine Pathologie und Pathologische Anatomie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Alexander Novotny
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Helmut Friess
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
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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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Andriandi, Cleven A, Hanff D, Hartgrink H, Dijkstra P. Presacral myelolipoma, case report and literature review. Ann Med Surg (Lond) 2020; 57:274-280. [PMID: 32904073 PMCID: PMC7452051 DOI: 10.1016/j.amsu.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Andriandi
- Department of Orthopaedic and Traumatology, Adam Malik General Hospital / Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
| | - A.H.G. Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - D.F. Hanff
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H. Hartgrink
- Department of Surgery Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - P.D.S. Dijkstra
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
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Rizzo G, Coramusi C, Pietricola G, Sionne F, Castri F, Pafundi DP, Aversa R, Coco C. Laparoscopic approach for a presacral myelolipoma resembling a liposarcoma. J Surg Case Rep 2018; 2018:rjy156. [PMID: 30018758 PMCID: PMC6041891 DOI: 10.1093/jscr/rjy156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Myelolipomas are rare benign tumors that are commonly found in the adrenal glands. Extra-adrenal locations are rare, and presacral myelolipomas represent the most common extra-adrenal location. The differential diagnosis of malignant presacral neoplasms is very challenging. We present a case of a presacral neoplasm that was completely removed with a laparoscopic approach and diagnosed as a myelolipoma only after pathological examination.
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Affiliation(s)
- G Rizzo
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Coramusi
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Pietricola
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Sionne
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Castri
- Polo Scienze della Salute della Donna e del Bambino-Area Anatomia Patologica-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - D P Pafundi
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Aversa
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Coco
- Polo Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche-Area Chirurgica Addominale-U.O.C. Chirurgia Generale Columbus-Fondazione Policlinico Universitario Agostino Gemelli IRCSS Università Cattolica del Sacro Cuore, Rome, Italy
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Sakamoto A, Nagamatsu I, Shiba E, Okamoto T, Hisaoka M, Matsuda S. Presacral myelolipoma as a possible parasymptom of cancer: A case report. Rare Tumors 2018; 10:2036361318772124. [PMID: 29760871 PMCID: PMC5946595 DOI: 10.1177/2036361318772124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022] Open
Abstract
Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements. Presacral myelolipomas can occur in patients with a medical history of malignancy, steroid use, and/or endocrine disorders including diabetes mellitus. A 65-year-old man with no specific medical history experienced temporal abdominal pain without bowel symptoms that lasted a few hours. By the time he visited a hospital, the pain had diminished. Computed tomography failed to detect any abnormality in the abdominal or pelvic organs that would have caused the abdominal pain but revealed a lesion 4 cm in diameter in the frontal sacrum. Magnetic resonance imaging showed that the lesion contained fat elements with a high signal intensity on T1- and T2-weighted images, which was decreased on fat-suppression T2-weighted images. Computed tomography-guided biopsy and imaging allowed a diagnosis of presacral myelolipoma. After 3 months, hematochezia was observed, and follow-up examination revealed rectal carcinoma with multiple lung metastases. He died due to spread of the cancer despite chemotherapy, 6 months after the cancer was found. Considering the possible association between presacral myelolipoma and cancer, presacral myelolipoma might be a cancer parasymptom. Checking for possible malignancy may therefore be warranted in patients with presacral myelolipoma, especially in those without diabetes mellitus.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Akio Sakamoto, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, 54 Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Iori Nagamatsu
- Department of Surgery, National Hospital Organization, Kokura Medical Center, Kitakyushu, Japan
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
RATIONALE Extra-adrenal myelolipoma in the presacral area often raises a concern for liposarcoma because they have similar radiologic features. PATIENT CONCERNS A 70-year-old woman with multiple abdominal surgeries in the past presented with persistent lower abdominal pain and anemia. A presacral mass, found on a pelvic magnetic resonance image (MRI), was suspicious of liposarcoma, as it is the most common fat containing mass in the presacral area. It is often difficult to make a diagnosis of myelolipoma just based on the radiological studies, which necessitates a histopathologic examination of the resected mass for a definitive diagnosis. DIAGNOSES Myelolipoma is an encapsulated, benign tumor containing mature adipocytes and hematologic cells. Most of the patients with myelolipoma remain asymptomatic but continued growth of tumor without local invasion can lead to compression of nearby structures, causing persistent pain. INTERVENTIONS Asymptomatic patients do not require intervention but surgical resection is indicated for persistent pain or hemorrhage inside the tumor. Our patient had 2 indications for surgery - persistent pain as well as a provisional diagnosis of liposarcoma. After the surgical resection, pelvic pain was resolved, and a diagnosis of myelolipoma was made based on histopathologic examination. OUTCOMES Patient was reassured that it was myelolipoma, a benign tumor, not requiring subsequent surveillance for recurrence. LESSONS Despite advancement in imaging techniques, and knowledge of the radiological features of myelolipoma, it still remains as a challenge for clinicians to make the distinction between liposarcoma and myelolipoma only based on diagnostic radiology. Although myelolipoma is a benign tumor, if patient suffers from persistent pain due to local mass effect, surgical resection is required.
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Affiliation(s)
- Min Ho Cho
- Department of Medicine, MedStar Washington Hospital Center
| | - Rohan Mandaliya
- Division of Gastroenterology and Hepatology, MedStar Georgetown University Hospital
| | - John Liang
- Department of Pathology, MedStar Washington Hospital Center, Washington, DC
| | - Mitesh Patel
- Division of Gastroenterology and Hepatology, MedStar Georgetown University Hospital
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Al-Ani Z, Fernando M, Wilkinson V, Kotnis N. The management of deep-seated, lowgrade lipomatous lesions. Br J Radiol 2018; 91:20170725. [PMID: 29303371 DOI: 10.1259/bjr.20170725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Deep-seated, low-grade lipomatous lesions detected on imaging often cause uncertainty for diagnosis and treatment. Confidently distinguishing lipomas from well-differentiated liposarcomas is often not possible on imaging. The approach to management of such lesions varies widely between institutions. Applying an evidenced-based approach set around published literature that clearly highlights how criteria such as lesion size, location, age and imaging features can be used to predict the risk of well-differentiated liposarcomas and subsequent de-differentiation would seem sensible. Our aim is to review the literature and produce a unified, evidence-based guideline that will be a useful tool for managing these lesions.
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Affiliation(s)
- Zeid Al-Ani
- 1 Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
| | - Malee Fernando
- 2 Pathology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
| | - Victoria Wilkinson
- 3 Radiology Department, Doncaster and Bassetlaw NHS Foundation Trust, Doncaster , United Kingdom
| | - Nikhil Kotnis
- 1 Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
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Incidental Presacral Myelolipoma Resembling the Liposarcoma: A Case Report and Literature Review. Case Rep Urol 2017; 2016:6510930. [PMID: 28116211 PMCID: PMC5225335 DOI: 10.1155/2016/6510930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
Abstract
Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male.
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Shen C, Zhou K, Lai Y, Fan J, Liu L, Che G. Review of primary extra-adrenal myelolipoma of the thorax. J Surg Res 2016; 207:131-137. [PMID: 27979469 DOI: 10.1016/j.jss.2016.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/09/2016] [Accepted: 08/24/2016] [Indexed: 02/05/2023]
Abstract
Extra-adrenal myelolipoma happens in adrenal glands, and the thoracic location is extremely unusual. This is the first study involving 36 of patients with thoracic myelolipoma of English literature by investigating the clinical data, pathologic findings, radiological manifestation, and treatment strategy of all patients. Imageologic diagnosis including computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography scans is useful to identify the feature of extra-adrenal myelolipoma. Pathologic analysis is an effective method to clarify the diagnosis. In view of the potential progressive enlargement of the lesion, most myelolipomas are removed by surgery, and this operation has frequently been accomplished by using video-assisted thoracic surgery.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Yutian Lai
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jun Fan
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China.
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