A Case of Extra-Adrenal Myelolipoma Arising from the Right Lateral Pelvic Area

Introduction. Adrenal myelolipoma is a rare tumor that is benign in nature, usually asymptomatic, unilateral, and nonsecreting. It is composed of variable mixture of mature adipose tissue and hematopoietic elements and develops within the adrenal gland. With the widespread use of cross-sectional imaging modalities such as ultrasonography and computed tomography, the incidental detection of these tumors is increasing in frequency.Case Presentation. We report a case of adrenal myelolipoma in a 63-year-old Kashmiri male, who presented with pain in the right upper abdomen. Physical examination was unremarkable. Ultrasound abdomen showed the presence of a hyperechoic mass in the right suprarenal region with undefined margins. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed a well-defined, round lesion in the right suprarenal region with heterogeneous attenuation suggesting the possibility of myelolipoma. The patient was subjected to right adrenalectomy and his postoperative course was uneventful. The histopathological evaluation of the mass confirmed the initial diagnosis of adrenal myelolipoma.Conclusion. Although mostly discovered as an “incidentaloma”, the diagnosis of adrenal myelolipoma warrants thorough diagnostic study. Imaging techniques such as ultrasonography and CT scans as well as biochemical studies are useful for indicating the best treatment taking into account the size of the mass and possible hormone production. Surgical resection is advocated through extraperitoneal approach as it minimizes postoperative complications and leads to quicker recovery.

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Lipomatous tumours in adrenal gland: WHO updates and clinical implications

Endocrine Related Cancer ◽

10.1530/erc-16-0564 ◽

2017 ◽

Vol 24 (3) ◽

pp. R65-R79 ◽

Cited By ~ 16

Author(s):

Alfred King-yin Lam

Keyword(s):

Adrenal Gland ◽

Age Distribution ◽

World Health ◽

Adrenal Myelolipoma ◽

Adrenal Tumours ◽

Endocrine Organs ◽

Lipomatous Tumour ◽

Health Organization ◽

The Right

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.

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Giant adrenal myelolipoma associated with 21-hydroxylase deficiency: unusual association mimicking an androgen-secreting adrenocortical carcinoma

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000400012 ◽

2010 ◽

Vol 54 (4) ◽

pp. 419-424 ◽

Cited By ~ 19

Author(s):

Lívia Mara Mermejo ◽

Jorge Elias Junior ◽

Fabiano Pinto Saggioro ◽

Silvio Tucci Junior ◽

Margaret de Castro ◽

...

Keyword(s):

Differential Diagnosis ◽

Adrenal Gland ◽

Adrenocortical Carcinoma ◽

Adrenal Mass ◽

Surgical Excision ◽

Abdominal Ultrasound ◽

Hydroxylase Deficiency ◽

Adrenal Myelolipoma ◽

The Right ◽

21 Hydroxylase Deficiency

The objective of this study was to describe a case of giant myelolipoma associated with undiagnosed congenital adrenal hyperplasia (CAH) due to 21-hydroxylase (21OH) deficiency. Five seven year-old male patient referred with abdominal ultrasound revealing a left adrenal mass. Biochemical investigation revealed hyperandrogenism and imaging exams characterized a large heterogeneous left adrenal mass with interweaving free fat tissue, compatible with the diagnosis of myelolipoma, and a 1.5 cm nodule in the right adrenal gland. Biochemical correlation has brought concerns about differential diagnosis with adrenocortical carcinoma, and surgical excision of the left adrenal mass was indicated. Anatomopathologic findings revealed a myelolipoma and multinodular hyperplasic adrenocortex. Further investigation resulted in the diagnosis of CAH due to 21OH deficiency. Concluded that CAH has been shown to be associated with adrenocortical tumors. Although rare, myelolipoma associated with CAH should be included in the differential diagnosis of adrenal gland masses. Moreover, CAH should always be ruled out in incidentally detected adrenal masses to avoid unnecessary surgical procedures.

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Diagnosis and Management of a Large Adrenal Myelolipoma

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0040-1721519 ◽

2020 ◽

Vol 6 (02) ◽

pp. 70-73

Author(s):

Imad Ghantous ◽

Melissa Kyriakos Saad ◽

Toufic Saber ◽

Elissa Mahfouz ◽

Imad Matta ◽

...

Keyword(s):

Computed Tomography ◽

Rare Condition ◽

Abdominal Distension ◽

Mass Effect ◽

Caucasian Patient ◽

Computed Tomography Scan ◽

Adrenal Myelolipoma ◽

The Right ◽

Real Challenge ◽

Tomography Scan

AbstractAdrenal myelolipoma is a rare condition. Although benign in nature, these tumors can increase in size and cause a mass effect to nearby structures presenting as abdominal distension and pain. In 90% of cases, adrenal myelolipomas are unilateral. However, the real challenge in management is when bilateral adrenal myelolipoma is present. Herein, we present a case of a 51-year-old male Caucasian patient with bilateral adrenal myelolipoma. The patient had a large left adrenal myelolipoma (23 × 13 cm) and a small one on the right (4.4 × 4 cm). We opted for an open left adrenalectomy due to classical features on computed tomography scan and the mass effect of the tumor.

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Case Report of a Giant Adrenal Myelolipoma in a Patient with Sickle Cell Anaemia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1731032 ◽

2021 ◽

pp. 88-93

Author(s):

Udochikwuka Patience Ikejiaku ◽

Chidinma Adaobi Udah ◽

Johnpatrick Uchenna Ugwoegbu ◽

Emeka Nwolisa

Keyword(s):

Case Report ◽

Physical Examination ◽

Sickle Cell ◽

Sickle Cell Anaemia ◽

Imaging Techniques ◽

Vena Cava ◽

Operative Management ◽

Lumbar Region ◽

Adrenal Myelolipoma ◽

The Right

Adrenal myelolipomas (AMLs) are rare benign adrenal tumours containing adipose and hematopoietic tissue as a result of reticuloendothelial cell metaplasia. In this case report, we describe the diagnostic evaluation and the operative management of a giant adrenal myelolipoma in a 14-year-old male who has sickle cell anaemia. He presented with a one-week history of bilateral leg swelling. A physical examination revealed a mass in the right lumbar region. Ultrasound of the abdomen revealed a well-defined rounded echo-complex encapsulated supra-renal mass impinging on the upper pole of the right kidney, displacing it downwards. There was also marked compression of the inferior vena cava. A computed tomography scan showed a large mass occupying the right adrenal gland. The patient had an exploratory laparotomy with excision of the right adrenal tumour. Histopathological (Immunohistochemistry) evaluation of the mass confirmed the diagnosis of adrenal myelolipoma. The diagnosis of an adrenal myelolipoma requires a good history, physical examination, a high index of suspicion, imaging techniques, and a thorough histopathological evaluation. Surgery is the main treatment modality and good post-operative management minimizes complications and guarantees rapid recovery.

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Iliopsoas haematoma in a rugby player

South African Journal of Sports Medicine ◽

10.17159/2413-3108/2015/v27i2a493 ◽

2016 ◽

Vol 27 (2) ◽

pp. 55

Author(s):

D C Janse van Rensburg

Keyword(s):

Nerve Palsy ◽

Femoral Nerve ◽

Young Athlete ◽

Sports Injury ◽

Iliopsoas Muscle ◽

Lower Back ◽

Pelvic Area ◽

The Right ◽

Hip Flexor ◽

Rare Diagnosis

Traumatic iliopsoas haematoma is a serious complication of haemorrhage disorders rarely seen in young healthy athletes. It is mostly describedin patients on anticoagulant therapy and commonly associated with various degrees of femoral nerve palsy. A 22-year-old male rugby playerpresented with severe onset of pain in the lower back, right hip flexor/pelvic area following a tackle during a rugby match. Magnetic resonanceimaging identified a distinct, hyperechoic heterogeneous mass within the right iliopsoas muscle, confirming a diagnosis of iliopsoas haematoma.The case resolved completely after conservative medical treatment in addition to a period of rest and intense active physical therapy. This casestudy reports the rare diagnosis of an uncomplicated iliopsoas haematoma following a sports injury in a young athlete.

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Laparoscopic Hand-Assisted Adrenal-Sparing Surgery for a Giant Adrenal Myelolipoma: A Case Report

International Surgery ◽

10.9738/intsurg-d-14-00289.1 ◽

2018 ◽

Vol 102 (9-10) ◽

pp. 469-472

Author(s):

Bong Hee Park ◽

Su Lim Lee ◽

Kyung Jin Seo ◽

Sang Rak Bae ◽

Yong Seok Lee ◽

...

Keyword(s):

Adrenal Gland ◽

Residual Tumor ◽

Postoperative Recovery ◽

Adrenal Tumors ◽

Partial Adrenalectomy ◽

Adrenal Myelolipoma ◽

First Line Therapy ◽

Rare Benign Tumor ◽

The Right

Adrenal myelolipoma is a rare, benign tumor. Surgical resection is advocated in symptomatic cases, large (size >4 cm) cases, cases where there is an increase in size on follow-up, and cases with an atypical appearance on imaging. Laparoscopic adrenalectomy is currently the gold standard operation for managing benign adrenal mass. However, to date, laparoscopic entire resection of ipsilateral adrenal gland with the tumor has mainly been reported in the literature. Under clinical circumstances, adrenal-sparing surgery is underused as first-line therapy for adrenal tumors. We present a case of adrenal myelolipoma involving the right adrenal gland of a 45-year-old woman who presented with right-sided flank pain. On radiologic and endocrine evaluation, she received a diagnosis of a giant adrenal myelolipoma (>8 cm). Right hand-assisted laparoscopic partial adrenalectomy was performed, and postoperative recovery was uneventful. Finally, histologic examination confirmed adrenal myelolipoma. On follow-up computed tomography, there was no residual tumor and the remaining right adrenal gland. Our report suggests that hand-assisted laparoscopic partial adrenalectomy could be considered for appropriate removal of adrenal myelolipoma, even in giant adrenal myelolipoma.

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Retroperitoneal Hemorrhage Due to a Ruptured Adrenal Myelolipoma

Acta Radiologica ◽

10.1177/02841851960373p254 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 688-690 ◽

Cited By ~ 7

Author(s):

O. Catalano

Keyword(s):

Literature Review ◽

Adrenal Gland ◽

Acute Pain ◽

Retroperitoneal Hemorrhage ◽

Adrenal Myelolipoma ◽

Retroperitoneal Bleeding ◽

The Right

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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Compliance Issues in Managing 21 Hydroxylase Deficiency and their Short/Long-Term Consequences

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_003048 ◽

2021 ◽

Author(s):

Jack Lin ◽

Teck K Khoo ◽

Erin R Voelschow ◽

Zachary J Viets

Keyword(s):

Hormonal Treatment ◽

Vascular Compression ◽

Long Term Effects ◽

Hydroxylase Deficiency ◽

Adrenal Myelolipoma ◽

Male Birth ◽

Adrenal Masses ◽

The Right ◽

21 Hydroxylase Deficiency

Objective: To report a case of untreated classic 21 hydroxylase (OH) deficiency congenital adrenal hyperplasia (CAH) in a transgender patient resulting in pulmonary embolisms (PEs) and bilateral adrenal masses. Methods: A 36-year-old male (birth sex: female) presenting with bilateral PEs in the setting of long-standing, untreated classic 21OH CAH was also found to have bilateral adrenal masses (unconfirmed myelolipomas). Results: Further history revealed a known diagnosis of CAH. The patient had been treated with glucocorticoid and mineralocorticoid replacement in childhood but stopped taking these medications against medical advice. During his hospital admission, he was noted to have elevated 17-hydroxyprogesterone, low cortisol with elevated ACTH levels, and male-level testosterone measurements. CT of the abdomen/ pelvis revealed a 23 cm mass in the left renal fossa and a 2.5 cm mass in the right renal fossa consistent with bilateral adrenal myelolipomas. The patient attended follow-up in clinic, but declined any further hormonal treatment as he identified as male and felt further treatment was unnecessary. Conclusion: This case demonstrated the unique long-term effects of untreated classic CAH due to 21OH deficiency, including bilateral adrenal myelolipoma, adrenal compensation to the point of producing male-level androgens, and possibly PEs. Treatment with hydrocortisone was recommended to suppress ACTH and it was planned that the patient would eventually start on testosterone (although this would have been complicated by his bilateral PEs). Potential aetiologies for the PEs included vascular compression of the renal artery (which could explain the elevated EPO/erythrocytosis contributing to hypercoagulability) or the renal vein by the adrenal mass.

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Giant Bilateral Adrenal Myelolipoma with Congenital Adrenal Hyperplasia

Case Reports in Surgery ◽

10.1155/2014/728198 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

S. Al-Bahri ◽

A. Tariq ◽

B. Lowentritt ◽

D. V. Nasrallah

Keyword(s):

Congenital Adrenal Hyperplasia ◽

Abdominal Distension ◽

Adrenal Hyperplasia ◽

Hematopoietic Tissue ◽

Hydroxylase Deficiency ◽

Adrenal Myelolipoma ◽

Massive Growth ◽

History Of ◽

Adrenal Masses ◽

The Right

Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-αhydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing’s syndrome, Addison’s disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.

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