Giant adrenal myelolipoma

Case contributed by Amr Farouk
Diagnosis certain

Presentation

Right lumbar dull aching pain over several months.

Patient Data

Age: 50 years
Gender: Female

C+ computed tomography CT

ct

A large mass is seen in the retroperitoneum on the superior and lateral aspects of right kidney, which is displaced inferiorly. The mass is seen pushing the pancreatic head and IVC medially. Superiorly it is seen invaginating and scalloping the liver posteriorly with stretching of the portal vein. The mass appeared largely fatty with areas of higher attenuation inside. Density on CT varied between -15HU peripherally to -25HU in the center.

Surgery was performed through a right subcostal incision for the extraperitoneal approach of the right adrenal gland. The mass was totally dissected from the right kidney and excised. Macroscopic examination of the mass revealed a giant mass measuring 19×16×7 cm, surrounded by a thin capsule.

The pathology report gross showed a well defined mass with serial sections showing intermixed yellowish and reddish areas. No necrosis could be detected. Histologic section examined revealed a benign tumor formed of lobules of mature adipocytes with revealed clear vacuolated cytoplasm and peripherally pushed flat nuclei, in between the adipocytes a pleomorphic infiltrate is seen formed of megakaryocytes, granulocytes and erythrocytes. Consistent with myelolipoma of the right adrenal gland.

Case Discussion

Myelolipomas are rare benign tumors of the adrenal gland with varying proportions of hematopoietic and adipose tissue. These lesions rarely measure more than five cms in diameter although giant tumors have been occasionally reported. 

Giant myelolipomas are quite rare lesions which may be asymptomatic or because of their large size may lead to dragging abdominal pain, an abdominal mass, compression of neighboring organs and even acute intratumoral or retroperitoneal hemorrhage. 

The main differential diagnosis will be liposarcoma based on the large size of the tumor and presence of adipose components.

Giant adrenal myelolipomas are usually treated by simple adrenalectomy and are completely curable. Hence an awareness of this rare adrenal entity and its correct diagnosis is important.

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