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. 2014;5(8):494-6.
doi: 10.1016/j.ijscr.2014.04.001. Epub 2014 Jun 18.

Adrenal myelolipoma: To operate or not? A case report and review of the literature

Mary Ramirez  1 , Subhasis Misra  2
Affiliations

Adrenal myelolipoma: To operate or not? A case report and review of the literature

Mary Ramirez et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Myelolipoma is a rare, benign neoplasm that predominantly occurs in the adrenal gland and is composed of mature adipose tissue and scattered islands of hematopoietic elements. Although usually small and asymptomatic, there are some cases of adrenal myelolipoma that cause symptoms such as chronic pain. Elective surgery can prevent a more severe symptom presentation and life threatening progression while also allowing accurate diagnosis in patients with tumors larger than 6cm.

Presentation of case: This report presents an unusual case of a 28-year-old female who suffered with chronic pain from a growing left-sided adrenal myelolipoma. Without the financial means for additional testing along with many symptoms warranting a high suspicion for malignancy, this patient decided to have the mass surgically excised, which was both diagnostic and curative.

Discussion: For this specific patient, surgery was the most cost effective option, as well as both diagnostic and curative. Surgery can also prevent complications such as spontaneous rupture and hemorrhage of the mass, which can lead to subsequent cardiovascular shock.

Conclusion: Management of adrenal myelolipoma should be considered on an individual basis. Although it is a benign tumor, surgery plays an important role for symptomatic cases and those lesions that cannot be distinguished reliably from malignancy.

Keywords: Adrenal myelolipoma; Incidental adenoma.

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Figures

Picture 1
Picture 1
(A) CT scan showing loss of a fat plane between the mass and the pancreas (yellow arrow). (B) CT scan showing local invasion of the spleen (red arrow).
Picture 2
Picture 2
(A) Histopathologic picture of myelolipoma composed of mature fat cells mixed with hematopoietic elements. (B) Magnified view of (A).
See this image and copyright information in PMC

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