DOI: http://dx.doi.org/10.18203/2349-2902.isj20200321

Very rare giant adrenal myelolipoma: a tumor mimic

Aditya Prasad Padhy, Abinash Kanungo, Deepak Kumar Das, Sunny .

Abstract


Adrenal myelolipoma is a very rare benign neoplasm usually unilateral, and nonsecreting, occurring in the adrenal gland which consist of fatty tissues and hematopoietic elements. Some cases of this type may cause symptoms like chronic abdominal pain however usually these tumors are small and asymptomatic. Surgery is the modality of treatment where there are severe symptoms with life threatening progression with size of tumor reaching more than 6 cm. Here we report an unusual case of a 59-year-old male with history of chronic abdominal pain from a growing right-sided large adrenal mass. With all possible hematological, histo-pathological as well as imaging investigations warranted a high suspicion for tumor mass, hence decided for surgically excision, which was both diagnostic as well as curative. The histopathological study of the excised mass confirmed the initial diagnosis of adrenal myelolipoma. Surgery is the diagnostic and curative modality of treatment for adrenal myelolipoma after all possible investigations to reach for a clinical diagnosis as well for proper planning for surgery. By this we can prevent complications like spontaneous rupture and hemorrhage of the mass, and subsequent cardiovascular shock. Management varies from individual to individual. Open radical adrenalectomy is the standard treatment for giant myelolipomas (size >10 cm), while the minimally invasive approach has been used in only few cases of small sized tumors. Although it is a benign tumor, surgery plays main role for symptomatic cases and high suspicion of malignancy.

Keywords


Adrenal myelolipoma, Adrenal gland, Benign condition, Surgical excision

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References


Ersoy E, Ozdoğan M, Demirağ A, Aktimur R, Kulaçoğlu H, Kulaçoğlu S, et al., “Giant adrenal ˘myelolipoma associated with small bowel leiomyosarcoma: a case report. Turk J Gastroenterol. 2006 Jun;17(2):126-9.

Daneshmand S, Quek ML, Adrenal myelolipoma: diagnosis and management. J Urology. 2006;l(3):71-4.

Al Bahri S, Tariq A, Lowentritt B, Nasrallah DV. Hindawi Publishing Corporation: Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia. Case Rep Surg. 2014;728198:2014.

Ramirez M, Misra S. Adrenal myelolipoma: To operate or not? A case report and review of the literature. Int J Surg Case Rep. 2014;5:494-6.

Lam AK. Update on adrenal tumours in 2017 World Health Organization (WHO) of endocrine tumours. Endocr Pathol. 2017;28:213-27.

Bokhari MR, Bhimji S. Adrenal, myelolipoma. Stat Pearls. NCBI Bookshelf; 2017.

Brogna A, Scalisi G, Ferrara R, Bucceri AM. Giant secreting adrenal myelolipoma in a man: a case report. J Med Case Reports. 2011;5:298.

Zhao J, Sun F, Jing X, Zhou W, Huang X, Wang H, et al. The diagnosis and treatment of primary adrenal lipomatous tumours in Chinese patients: A 31-year follow-up study. Can Urol Assoc J. 2014;8:E132-E136.

Molnar C, Lata L, Pisica R, Russu C, Gherghinescu M, Molnar C, et al. Anterior transabdominal laparoscopic adrenalectomy, without ligatures, for a symptomatic right adrenal myelolipoma with intratumorally haemorrhage. Chirurgia (Bucur). 2017;112:58-62.

Porcaro AB, Novella G, Ficarra V, Cavalleri S, Antoniolli SZ, Curti P, “Incidentally discovered adrenal myelolipoma. Report on 3 operated patients and update of the literature.” Archivio Italiano di Urologia, Andrologia. 2002;74(3):146–51.

Tyritzis SI, Adamakis I, Migdalis V, Vlachodimitropoulos D, Constantinides CA. Giant adrenal myelolipoma, a rare urological issue with increasing incidence: a case report.” Cases J. 2009;2(9):8863.

Kenney PJ, Wagner BJ, Rao P, Heffess CS, “Myelolipoma: CT and pathologic features,” Radiology. 1998;208(1):87–95.

Rep´assy DL, Csata S, Sterlik G, Iv´anyi A. Giant adrenal ´myelolipoma. Pathol Oncol Res. 2001;7:72–3.

Tsuru K. Ushiyama ST Ozono S. Laparoscopic adrenalectomy for large adrenal tumors.” J Endourol. 2005;19(5):537-40.