Giant adrenal lipoma: a report of two cases and review of literature

Adrenal lipoma: A case report and literature review

The study reports a case of a 57-year-old female patient with incidental right adrenal lipoma (LA). The tumor was detected by ultrasound (US) and confirmed by computed tomography (CT).

Due to the size of the mass, it was decided to perform a laparoscopic adrenalectomy.

During the differential microscopic diagnosis, were considered adrenal lipomatous tumors, myelolipoma, angiomyolipoma and teratomas, among others.

In all these neoplasms, LA is a rare tumor, with only 24 cases reported in the anglo-saxon literature revised.

It is a benign adrenal gland tumor with generally asymptomatic and non-functioning nature.

Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours

The fourth edition of the World Health Organization (WHO) classification of endocrine tumours contains substantial new findings for the adrenal tumours. The tumours are presented in two chapters labelled as "Tumours of the adrenal cortex" and "Tumours of the adrenal medulla and extra-adrenal paraganglia." Tumours of the adrenal cortex are classified as cortical carcinoma, cortical adenoma, sex cord stromal tumours, adenomatoid tumour, mesenchymal and stromal tumours (myelolipoma and schwannoma), haematological tumours, and secondary tumours. Amongst them, schwannoma and haematological tumours are newly documented. The major updates in adrenal cortical lesions are noted in the genetics of the cortical carcinoma and cortical adenoma based on the data from The Cancer Genome Atlas (TCGA). Also, a system for differentiation of oncocytoma from oncocytic cortical carcinoma is adopted. Tumours of the adrenal medulla and extra-adrenal paraganglia comprise pheochromocytoma, paraganglioma (head and neck paraganglioma and sympathetic paraganglioma), neuroblastic tumours (neuroblastoma, nodular ganglioneuroblastoma, intermixed ganglioneuroblastoma, and ganglioneuroma), composite pheochromocytoma, and composite paraganglioma. In this group, neuroblastic tumours are newly included in the classification. The clinical features, histology, associated pathologies, genetics, and predictive factors of pheochromocytoma and paraganglioma are the main changes introduced in this chapter of WHO classification of endocrine tumours. The term "metastatic pheochromocytoma/paraganglioma" is used to replace "malignant pheochromocytoma/paraganglioma." Also, composite pheochromocytoma and composite paraganglioma are now documented in separate sections instead of one. Overall, the new classification incorporated new data on pathology, clinical behaviour, and genetics of the adrenal tumours that are important for current management of patients with these tumours.

Lipomatous tumours in adrenal gland: WHO updates and clinical implications

Adrenal lipomatous tumour is a group of adrenal tumours with a significant component of adipose tissue. According to the current World Health Organization (WHO) classification of tumours of endocrine organs, adrenal myelolipoma is the only entity amongst the group of tumours being described. In the literature, other more recently documented adrenal lipomatous tumours included 24 lipomas, 32 teratomas and 16 angiomyolipomas. Rare fatty tumours of the adrenal gland comprised liposarcoma, hibernoma, adrenocortical tumours with fat component and rare adrenal tumours with fat component. Myelolipoma comprises approximately 3% of primary adrenal tumour. It is noted more commonly in females and in the right adrenal gland. Approximately 40 bilateral myelolipomas were reported. The tumour is most frequently recorded in patients between fifth and seventh decades of life. Adrenal lipomas are often seen in males and in the right adrenal gland. They were commonly noted in patients in the sixth decade of life. The diagnosis could only be possible on examination of the surgically removed specimen. Adrenal teratomas were more common in females and with a bimodal age distribution. Slightly over 60% of the patients with adrenal teratoma are symptomatic. Adrenal angiomyolipomas were often symptomatic, more common in females and in the fifth decades of life. To conclude, adrenal lipomatous tumour is uncommon. They are often benign and non-functional. It is important to recognize the features of this group of lipomatous tumours in the adrenal gland as they are being detected on increasing incidence as a result of the wide-spread use of modern imaging modalities.

Neurocytoma arising in an adrenal gland mature teratoma

Mature teratoma of adrenal gland is a rare entity. Neurocytoma is a low grade neuronal tumor even rarely seen among central nervous system tumors. Nervous system tumors arising in teratomas are frequently originated from glial or primitive neuroectodermal cells. Here we report a neurocytoma arising in mature cystic teratoma in the right adrenal gland of an 8 years old boy. Histological examination revealed a tumor composed of solid sheets in fibrillar basis with small uniform cells in the neuroglial tissue in teratoma. This is only the second case demonstrating a neurocytoma arising in a mature cystic teratoma in the literature.

Acute abdominal pain secondary to retroperitoneal bleeding from a giant adrenal lipoma with review of literature

Adrenal lipomas are rare, non-functioning benign tumours, which are primarily detected during autopsy or imaging, as asymptomatic incidentalomas. Occasionally, they can present with abdominal pain due to their large size. Imaging studies help to determine the origin, volume, composition of the lesion and presence of bleeding. Histopathology, however, is necessary to differentiate an adrenal lipoma from other fatty tumours such as myelolipoma, angiomyolipomas, teratomas and liposarcomas. We report a case of spontaneous bleeding from a giant adrenal lipoma that presented as an acute abdomen, and was initially mistaken on imaging for the more common myelolipoma. The literature is reviewed to discuss the clinical, pathological and radiological features, and the optimum therapeutic management.

Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution

AIMS

Fatty tumours of the adrenal gland are uncommon and their features have received little attention in the literature. The aim of this study is to analyse the features of adrenal lipomatous tumours.

METHODS

The histological features of primary adrenal tumours reported over a 30 year period (1970 to 1999) in Queen Mary Hospital, Hong Kong were reviewed and the clinicopathological features of adrenal lipomatous tumours were analysed.

RESULTS

Adrenal lipomatous tumours were noted in 20 patients (12 men, eight women), and they accounted for 4.8% of the primary adrenal tumours reported. The adrenal fatty tumours comprised 11 myelolipomas, three lipomas, three teratomas, two angiomyolipomas, and one liposarcoma. Calcification or bone was noted in one third (seven of 20) of the adrenal tumours. In some fatty tumours (myelolipoma and angiomyolipoma), the fatty component may be inconspicuous. This is the first report in the English literature of angiomyolipoma and liposarcoma of the adrenal gland.

CONCLUSIONS

Different types of fatty tumours were noted in the adrenal gland. A high index of suspicion should be maintained with an aim of surgical treatment for selected patients with large and symptomatic adrenal lipomatous lesions. Histological confirmation is needed for diagnosis.

Lipoma of the adrenal gland

A rare case of a lipoma of the adrenal gland is reported with a review of the literature. The tumor was incidentally found at autopsy in a 50-year-old man who died from severe head trauma after a traffic injury. At autopsy, an oval-shaped, soft yellow nodule measuring 1.1 cm in diameter was found in the right adrenal cortex. Histological examination revealed a lesion consisting of mature adipose tissue partially surrounded by a thin fibrous capsule. On serial sections there was no evidence of hematopoiesis nor of adrenal medulla cells. To the best of our knowledge, this is the eighth case described in the English literature. With the increasing use and the high resolution of modern imaging techniques, these unsuspected adrenal masses may become more prevalent.

Teratoma in the region of adrenal gland: a unique entity masquerading as lipomatous adrenal tumor

BACKGROUND

The aim of this study was to establish the clinical and pathologic aspects of 3 atypical lipomatous lesions in the region of the adrenal gland.

METHODS

Three young Chinese patients (ages 18, 18, and 37 years) were seen for nonspecific back pain. Radiologic examination revealed a lipomatous lesion in the region of the adrenal gland, and hormonal assessment was normal. Calcification was noted in 2 of the 3 lesions. Adrenalectomy was performed because of the size (diameter 7.5, 10, 11 cm) of the tumors with suspected local symptoms.

RESULTS

On gross examination 2 tumors were cystic and 1 was solid. In all 3 patients the diagnosis was mature teratomas. The tumors were composed of mature tissues arising from more than 1 germinal layer. There was no evidence of immature elements or malignancy. Adipose tissue was the predominant component in the tumors. There was no evidence of recurrent diseases in all these patients during follow-up.

CONCLUSIONS

To our knowledge, this is the first report of teratomas occurring in the adrenal region. Teratoma should clinically and radiologically be included in the differential diagnoses of lipomatous adrenal lesions. Excision of the teratoma is advocated.