Year : 2010 | Volume
: 53 | Issue : 2 | Page : 325--326
Giant adrenal myelolipoma
Gwendolyn C Fernandes, Rajib K Gupta, Bhuvaneshwari M Kandalkar
Department of Pathology, Seth G. S. Medical College and KEM Hospital, India
Gwendolyn C Fernandes
1/B7, Queens Marigold CHS, Queens Park, Behind Deepak Hospital, Off Mira Bhayander Highway, Mira Road (E), Thane, Maharashtra, 401 105
Adrenal myelolipoma is a rare benign tumor composed of adipose and hematopoietic tissue. Most tumors are small in size and incidentally detected. We report a case of giant adrenal myelolipoma weighing 2200 gms which was diagnosed on radiology as a liposarcoma. This case is unusual in view of the large size and presence of bony spicules. To the best of our knowledge, not more than 10 giant adrenal myelolipoma cases have been reported in literature.
|How to cite this article:|
Fernandes GC, Gupta RK, Kandalkar BM. Giant adrenal myelolipoma.Indian J Pathol Microbiol 2010;53:325-326
|How to cite this URL:|
Fernandes GC, Gupta RK, Kandalkar BM. Giant adrenal myelolipoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2022 Oct 7 ];53:325-326
Available from: https://www.ijpmonline.org/text.asp?2010/53/2/325/64314
Adrenal myelolipomas are uncommon tumors with varying proportions of mature fat and hematopoietic elements. They are usually small, asymptomatic, unilateral and giant forms which are extremely rare. They can be mistaken radiologically for a retroperitoneal liposarcoma. Giant myelolipomas can be asymptomatic or present with dragging abdominal pain, feeling of an abdominal mass, compression of surrounding structures and retroperitoneal hemorrhage.
A 48-year-old man presented with dull aching abdominal pain for one month. A firm, fixed, non-tender mass was palpable in the right flank. A computed tomography (CT) scan revealed a 28 x 20 x 15 cms hypoechoic mass on the right side of the abdomen reaching the midline and pushing the right kidney downwards and was suggestive of a retroperitoneal liposarcoma. Endocrine evaluation was done which included serum cortisol, serum catecholamines, urinary vanillylmandelic acid, 17-ketosteroid and testosterone levels; all were within normal limits.
Surgical excision was done. At surgery, a large encapsulated tumor mass was found in the region of the right adrenal replacing the adrenal gland. The right kidney was displaced inferiorly and the inferior vena cava medially, but the tumor was not adherent to any of the surrounding structures.
Gross and microscopic findings
Gross examination of the surgically excised specimen showed a 28x18x12cms thinly encapsulated tumor weighing 2200 gms, which was yellow with a few brown areas on its external surface [Figure 1]. On cutting, the tumor was bright yellow, greasy with a few irregular reddish - brown areas at the periphery. An occasional small bony spicule 0.5 x 0.4cm was seen in the center of the tumor. Microscopic examination revealed that the tumor was composed predominantly of mature adipocytes interspersed with hemopoietic tissue [Figure 2]. The hematopoietic tissue contained erythroid, granulocytic cell lines, few lymphoid cells and many megakaryocytes. A thin rim of normal adrenal tissue was seen in one of the sections. , A diagnosis of giant adrenal myelolipoma was made.
Myelolipomas are rare benign tumors of the adrenal gland with varying proportions of hematopoietic and adipose tissue. , The tumor was first described by Gierke in 1905 and given the name "myelolipoma" by Oberling in 1929.  It is largely reported as an incidental autopsy finding and the incidence in autopsy studies vary from 0.03 - 0.2%. They are now being diagnosed with increasing frequency as various radiological modalities are being increasingly available. 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. , Our patient presented with dull, aching abdominal pain.
A diagnosis of liposarcoma was made on CT based on the large size of the tumor and presence of adipose components. Case reports indicate that some of the larger myelolipomas have been misinterpreted as retroperitoneal liposarcomas on radiological examinations as was seen in our case.  An unusual feature in our case is the large size, most cases reported are small, and the presence of multiple tiny bony spicules which were, however, not in the vicinity of the hematopoietic elements.  Some myelolipomas can also coexist with adrenal adenomas.
Giant adrenal myelolipomas are usually treated by simple adrenalectomy and completely curable. Hence an awareness of this rare adrenal entity and its correct diagnosis is important.
|1||Wilhelmus JL, Schrodt GR, Alberhasky MT, Alcorn MO. Giant Adrenal Myelolipoma: case report and review of the literature. Arch Pathol Lab Med 1981;105:532-5.|
|2||Noble MJ, Montague DK, Levin HS. Myselolipoma: An Unusual Surgical Lesion of the Adrenal Gland. Cancer 1982;49:952-8.|
|3||Yildiz L, Akpolat I, Erzurumlu K, Aydin O, Kandemir B. Giant adrenal myelolipoma: Case report and review of literature. Pathol Int 2000;50:502-4.|
|4||Sanders R, Bissada N, Curry N, Gordon B. Clinical spectrum of adrenal myelolipoma: analysis of 8 tumours in 7 patients. J Urol 1995;153:1791-3.|
|5||Fernandez-Sanz J, Galera H, Garcia-Donas A, Gonzalez-Campora R, Llamas R, Matilla A. Adrenal myelolipoma simulating a retroperitoneal malignant neoplasm. J Urol 1981;126:780-2.|