The Internet Journal of Third World Medicine™ ISSN: 1539-4646

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Adrenal Myelolipoma: A Case Report

Puneet MS, DNB, MNAMS
Lecturer
Department of Surgery
Institute of Medical Sciences
Banaras Hindu University Physical Address

Satyendra K. Tiwary MS
Senior resident
Department of Surgery
Institute of Medical Sciences
Banaras Hindu University Physical Address

Sanjay Singh MS
Senior Resident
Department of Surgery
Ram Manohar Lohia Hospital Physical Address

Mohan Kumar MD
Professor
Department of Pathology
Institute of Medical Sciences
Banaras Hindu University Physical Address

V. K. Shukla MS, MCh
Professor
Department of Surgery
Institute of Medical Sciences
Banaras Hindu University Physical Address

Citation: Puneet, S. K. Tiwary, S. Singh, M. Kumar & V. Shukla : Adrenal Myelolipoma: A Case Report . The Internet Journal of Third World Medicine. 2006 Volume 3 Number 2

Keywords: adrenal | adrenal myelolipoma | adrenal tumour

 

Abstract

Adrenal myelolipoma is a rare benign condition. Most of these tumour are diagnose as an incidental finding during imaging. The asymtomatic patient with small lesion should be followed but symptomatic individual, functional tumour and large lesion are the indication of surgery. We report a case of adrenal myelolipoma.


Adrenal myelolipoma which is composed of hemopoietic and adipose elements is a rare benign tumor (1,2,3,4,5,6,7). Most adrenal myelolipomas are asymptomatic and are found incidentally (3). They occur usually in adults (1,3). The histogenesis of adrenal myelolipoma is not clear and this lesion has been found to be associated with endocrine disorders (4,5,6,7). The surgical treatment becomes necessary when the tumors size increases or it become symptomatic.

Case Report

A 55 year-old woman was admitted with intermittent right abdominal pain. There was no history of any past medical illness. Physical examination and laboratory tests were normal. Computerized tomography showed a large right retroperitoneal mass above the right kidney. A diagnosis of renal angiolipoma was considered (Figure 1). A laparotomy was performed revealing a large mass above the upper pole of the right kidney. The tumor was seperate from the right kidney so the kidney could be preserved. Pathologic examination showed a 483 gr 12x10x6 cm, well circumscribed solid tumor expanding the adrenal medulla. Microscopic examination showed proliferation of adipocytes and myeloid tissue which contains megakaryocytes, erythroid cells and lymphocytes (Figure 2). A diagnosis of myelolipoma of the adrenal gland was made.

Thumbnail: Figure 1: Computerized tomography; a large right retroperitoneal mass above the right kidney.
Figure 1: Computerized tomography; a large right retroperitoneal mass above the right kidney.

Thumbnail: Figure 2: Tumor composed mature adipose tissue and hemopoietic cells ( H&E x200).
Figure 2: Tumor composed mature adipose tissue and hemopoietic cells ( H&E x200).

Discussion

Adrenal myelolipoma is an uncommon benign tumor. Its frequency autopsy rangies from 0,08 to 0,4 % (7). It is diagnosed incidentally in most cases because of its non-functioning nature. It varies in size from microscopic foci to 34 cm. The adrenal myelolipoma cause is unknown. The pathogenesis of myelolipoma remains speculative(4,7). Theories of pathogenesis include retention of embryonic rests or extramedullary hematopoesis. The most favourable theory is of metaplastic origin (4). Microscopically adrenal myelolipoma consist of adipocytes and hematopoietic cells. Hemorrhage and calcification may be present was seen in our case(7). The differential diagnosis includes other fatty tumors of the adrenal gland (1). Adrenal myelolipoma has specific sonographic and computed tomographic feature and and sometimes a diagnosis of renal angiomyeolipoma, retroperitoneal lipoma, liposarcoma of the adrenal gland are considered in the differential diagnosis(2). When myeloid tissue, calcification or hemorrhage is too extensive the fat content may not be recognised. Although the majority of myelolipomas present as isolated adrenal masses, myelolipomatous foci have been reported in association with other adrenal pathologic conditions. These associated adrenal pathologic conditions include adrenocortical hyperplasia, adrenocortical adenomas, adrenocortical carcinomas, and endocrinologic dysfunctions, including Addison disease, Conn syndrome, 21-hydroxylase deficiency, 17-hydroxylase deficiency, and ectopic corticotropin production (4,6,7). A high index of suspicion should be maintained with surgical treatment being reserved for selected patients with large and symptomatic lesions. This case is unusual in view of the large size of the lesion making preoperative diagnosis difficult.

Corresponding Author:

Dr. Ibrahim METEOGLU
e-mail: [imete69@hotmail.com]
phone: 90-256-2120020
fax: 90-256-2120146
GSM: 90-542-2134308
Mailing Address: Adnan Menderes University Medical School,
Department of Pathology Aydin 09100 /Turkey

References

1. Bhansali A, Dash RJ, Singh SK, Behra A, Singh P, Radotra BD. Adrenal Myelolipoma: Profile of six patients with a brief review of literature. Int. J Endocrinol Metab 2003; 1: 33-40. (s)

2. Rocher L, Youssef N, Tasu JP, Paradis V, Blery M. Adrenal Pheochromocytoma and contralateral myelolipoma. Clin Radiol (s)

3. Dieckmann KP, Hamm B, Pichartz H, Jonas D, Baucer HW. Adrenal myelolipoma: clinical radiologic and histologic features. Urology 1987; 29: 1-8. (s)

4. Hofmockel G, Dammrich J, Manzanilla Garia H, Frohmuller H. Myelolipoma of the adrenal gland associated with contralateral renal cell carcinoma. Case report and review of literature. J Urol 1995; 153: 129-32. (s)

5. Kenney PJ, Wagner BJ, Rao P, Heffess CS. Myelolipoma: CT and pathologic features. Radiology 1998; 208: 87-95. (s)

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