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Shaker N, Shaker N, Alhalaseh Y, Sangueza OP, Abid A. Fine-needle aspiration cytology of presacral myelolipoma: Cytomorphological features of a rare entity and review of the literature. Cytopathology 2024; 35:317-320. [PMID: 38047439 DOI: 10.1111/cyt.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Presacral myelolipoma is an uncommon benign tumor, and its diagnosis can be challenging oncytology specimens. This case emphasizes the importance of fine needle aspiration cytology as an initial and valuable diagnostic tool for evaluating presacral masses. The identification of a combination of mature adipose tissue and hematopoietic elements in varying proportions is a crucial feature in FNA cytology. This underscores the role of FNA cytology in providing an accurate diagnosis and guiding subsequent management decisions.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nuha Shaker
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yazan Alhalaseh
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Omar P Sangueza
- Departments of Dermatology and Dermatopathology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Abdul Abid
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA
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2
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Xu C, Kasajima A, Novotny A, Friess H. Meta-analysis of reported presacral myelolipomas, including a report of a new case. J Med Case Rep 2023; 17:31. [PMID: 36721209 PMCID: PMC9890845 DOI: 10.1186/s13256-022-03746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Presacral myelolipomas form a rare disease and are often found incidentally in imaging diagnostics. CASE PRESENTATION In this study, we report the case of a 71-year-old caucasian female with an incidental finding of a retroperitoneal tumor on magnetic resonance imaging scan. This report aimed at presenting the clinical course of this patient with emphasis on analysis of pathological, clinical, and epidemiological features in a meta-analysis of reported cases. CONCLUSION Presacral myelolipomas are rare and its etiology remains unclear. Surgical resection is indicated in symptomatic lesions and lesions > 4 cm. More clinical and pathological research on this rare entity is warranted.
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Affiliation(s)
- Congde Xu
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Atsuko Kasajima
- grid.6936.a0000000123222966Klinikum rechts der Isar, Institut für Allgemeine Pathologie und Pathologische Anatomie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Alexander Novotny
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
| | - Helmut Friess
- grid.6936.a0000000123222966Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675 Munich, Deutschland
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Guillaume L, Vander Borght T, Bertrand C, Dupont M, Krug B. Presacral Myelolipoma: The Usefulness of a 99mTc-Albumin Nanocolloid Scintigraphy. Clin Nucl Med 2021; 46:38-39. [PMID: 33156042 DOI: 10.1097/rlu.0000000000003348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myelolipoma is a rare mesenchymal tumor consisting of adipose tissue and hematopoietic cells. Found usually in the adrenal region, however, few cases have been reported in extra-adrenal regions, most frequently in the presacral region. It is important to recognize such tumor, as it can attain massive size and causes pressure symptoms, and needs to be differentiated from malignant tumors, including liposarcomas. Although CT and MRI can suggest a diagnosis of myelolipoma, these are not conclusive. The hematopoietic cells are enhanced by a Tc-albumin nanocolloid scintigraphy and help to distinguish myolipoma from other entities.
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Affiliation(s)
| | | | | | - Michael Dupont
- Radiology, CHU UCL Namur, Université Catholique de Louvain, Namur, Belgium
| | - Bruno Krug
- From the Departments of Nuclear Medicine
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Andriandi, Cleven A, Hanff D, Hartgrink H, Dijkstra P. Presacral myelolipoma, case report and literature review. Ann Med Surg (Lond) 2020; 57:274-280. [PMID: 32904073 PMCID: PMC7452051 DOI: 10.1016/j.amsu.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Myelolipomas are very rare benign tumours consisting of hematopoietic cells and mature adipose tissues. They are most commonly found in the adrenal glands. However, there have been several reported cases of extra-adrenal myelolipomas, most commonly in the presacral region. Nearly all presacral lesions are small and asymptomatic; thus, most are discovered incidentally on imaging studies. PRESENTATION OF CASE We report two cases of presacral myelolipomas. The first is a 48-year-old female presenting with atypical back pain, found to have a mass in her presacral region with a size of 3,3 cm. The second case is a 59-year-old female, who presented for evaluation of a hip fracture, found to have a 4,7 cm presacral lesion. Both presacral myelolipomas were discovered incidentally and were confirmed by percutaneous guided fine-needle aspiration biopsy. Both were treated conservatively. DISCUSSION Accepted indications for the surgical excision of myelolipomas are symptomatic tumour, size >4 cm, metabolically active tumour, and a suspicion of malignancy on an imaging study. However, previous reports have documented that nearly half of the conservatively managed myelolipomas with a mean initial size of 5,1 cm, has increased in size or became symptomatic over a 3-years period. CONCLUSION We conclude that symptomatic presacral myelolipomas or lesions larger than 4 cm should be en-bloc resected, and we present an intuitive decision-making algorithm.
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Affiliation(s)
- Andriandi
- Department of Orthopaedic and Traumatology, Adam Malik General Hospital / Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
| | - A.H.G. Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - D.F. Hanff
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H. Hartgrink
- Department of Surgery Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - P.D.S. Dijkstra
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
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Merola G, Bracale U, Sodo M, Andreuccetti J, Pignata G. Laparoscopic treatment of mixed adenoneuroendocrine cancer of right colon: case report and review of literature. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sakamoto A, Nagamatsu I, Shiba E, Okamoto T, Hisaoka M, Matsuda S. Presacral myelolipoma as a possible parasymptom of cancer: A case report. Rare Tumors 2018; 10:2036361318772124. [PMID: 29760871 PMCID: PMC5946595 DOI: 10.1177/2036361318772124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022] Open
Abstract
Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements. Presacral myelolipomas can occur in patients with a medical history of malignancy, steroid use, and/or endocrine disorders including diabetes mellitus. A 65-year-old man with no specific medical history experienced temporal abdominal pain without bowel symptoms that lasted a few hours. By the time he visited a hospital, the pain had diminished. Computed tomography failed to detect any abnormality in the abdominal or pelvic organs that would have caused the abdominal pain but revealed a lesion 4 cm in diameter in the frontal sacrum. Magnetic resonance imaging showed that the lesion contained fat elements with a high signal intensity on T1- and T2-weighted images, which was decreased on fat-suppression T2-weighted images. Computed tomography-guided biopsy and imaging allowed a diagnosis of presacral myelolipoma. After 3 months, hematochezia was observed, and follow-up examination revealed rectal carcinoma with multiple lung metastases. He died due to spread of the cancer despite chemotherapy, 6 months after the cancer was found. Considering the possible association between presacral myelolipoma and cancer, presacral myelolipoma might be a cancer parasymptom. Checking for possible malignancy may therefore be warranted in patients with presacral myelolipoma, especially in those without diabetes mellitus.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Akio Sakamoto, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, 54 Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Iori Nagamatsu
- Department of Surgery, National Hospital Organization, Kokura Medical Center, Kitakyushu, Japan
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Presacral Myelolipoma: Diagnosis on Imaging With Pathologic and Clinical Correlation. AJR Am J Roentgenol 2016; 207:470-81. [DOI: 10.2214/ajr.15.15280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Toh JWT, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Colorectal Dis 2016; 18:337-50. [PMID: 26663419 DOI: 10.1111/codi.13232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
AIM The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. METHOD A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. RESULTS In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. CONCLUSION This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
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Affiliation(s)
- J W T Toh
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M Morgan
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Zeng Y, Ma Q, Lin L, Fu P, Shen Y, Luo QY, Zhao LH, Mou JH, Xiao HL. Giant Myelolipoma in the Spleen: A Rare Case Report and Literature Review. Int J Surg Pathol 2015; 24:177-80. [PMID: 26590175 DOI: 10.1177/1066896915617027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myelolipomas are benign tumors, consisting of hematopoietic cells and mature adipose tissue, which mainly occur within the adrenal gland. Extra-adrenal myelolipomas are rare, and fewer than 60 cases have been reported in the literature. Here, we report a case of intrasplenic myelolipoma in a 42-year-old man with more than 1 month of abdominal pain. Computed tomography scanning revealed a giant, heterogeneous, well-demarcated mass in the spleen. Splenectomy was performed, and an intrasplenic giant mass was completely excised. The diagnosis of myelolipoma was made based on morphological examination. To the best of our knowledge, this is the third reported case of myelolipoma in the human spleen.
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Affiliation(s)
- Ying Zeng
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Qiang Ma
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Li Lin
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Ping Fu
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Yan Shen
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Qing-Ya Luo
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Lian-Hua Zhao
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Jiang-Hong Mou
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Hua-Liang Xiao
- Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
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Sajjanar AB, Athanikar VS, Dinesh US, Nanjappa B, Patil PB. Non Functional Unilateral Adrenal Myelolipoma, A Case Report. J Clin Diagn Res 2015; 9:ED03-4. [PMID: 26266130 PMCID: PMC4525519 DOI: 10.7860/jcdr/2015/13209.6070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/09/2015] [Indexed: 11/24/2022]
Abstract
Adrenal myelolipoma is characterized by presence within the adrenal gland of mature adipose tissue and active bone marrow elements. Owing to their non functional nature most cases are incidental, either at autopsy or through computer tomography scan. Occasionally the lesions attain a large size to become clinically apparent. We present a case of a 58-year-old female with mass per abdomen. Preoperative computer tomography scan of abdomen, hormonal and urine analysis showed features of non functional adrenal myelolipoma. Gross specimen consists of unilateral ovoid mass, external surface having capsule with adherent fat and areas of congestion. Microscopic examination showed well encapsulated tumour tissue composed of mature adipose tissue with major blood forming elements like myeloid, erythroid and megakaryocytic series. The diagnosis was confirmed by histopathological examination of right sided adrenalectomy specimen.
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Affiliation(s)
- Anita B Sajjanar
- Assistant Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Vidisha S. Athanikar
- Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - U S Dinesh
- Professor, Department of Pathology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Bhuvnesh Nanjappa
- Associate Professor, Department of Urology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
| | - Preetam B. Patil
- Associate Professor, Department of Urology, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, India
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