1
|
Xu Z, Yang S, Tu Q, Han P, Wang L, Wang L, Tong M, Chen H. Clinical management of extra‑adrenal myelolipoma in the central nervous system: A case report. Exp Ther Med 2024; 28:327. [PMID: 38979018 PMCID: PMC11229403 DOI: 10.3892/etm.2024.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/10/2024] [Indexed: 07/10/2024] Open
Abstract
Extra-adrenal myelolipoma (EAM) is a rare benign tumor composed of mature adipose and hematopoietic tissues. Its etiology remains to be elucidated and there are few case reports describing the clinical features and treatment of EAMs in the central nervous system. The present study presented our experience and practice in the clinical management of a case of EAM in the right frontal region. A 56-year-old woman was found to have a space-occupying right frontal lesion on computed tomography (CT) of the head. Unenhanced magnetic resonance imaging (MRI) showed a lesion of ~1.5x1.2 cm. Enhanced whole abdominal CT showed a right presacral mass, 2.0 cm in diameter, with clear margins. The postoperative histopathological findings showed mainly mature adipose tissue mixed with extramedullary hematopoietic components. This confirmed the diagnosis of a (bone) marrow lipoma. Myelolipoma of the central nervous system is extremely rare. to the best of the authors' knowledge, only two cases of intracranial myelolipoma have been reported, and the present study introduced the first case in a Chinese patient reported in English. However, when CT shows high density and MRI shows mixed density in the tumor area even without enhancement, the possibility of myelolipoma should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Zhijian Xu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Song Yang
- Department of Neurosurgery, Jiaozhou Branch, East Hospital Affiliated to Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Qi Tu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Peiyue Han
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Lixia Wang
- Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Lude Wang
- Central Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Minfeng Tong
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Huahui Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
| |
Collapse
|
2
|
Sagar S, Hiwale KM, Gadkari P, Naseri S, Khan S, Jagtap MM. Stealthy Encroachment: Unraveling an Encounter With Renal Myelolipoma. Cureus 2024; 16:e58628. [PMID: 38770489 PMCID: PMC11103626 DOI: 10.7759/cureus.58628] [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: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Myelolipoma of the kidney is an exceedingly unusual benign tumor of hematological components mixed with mature adipose tissue. We present a case of a 59-year-old male who presented with left flank pain and was found to have an atrophic left kidney on imaging studies. A computed tomography (CT) scan revealed a small and shrunken left kidney with an extrarenal pelvis. A diethylenetriamine pentaacetate (DTPA) scan results showed a total glomerular filtration rate (GFR) of 45.6 ml/min with a non-functional left kidney. The patient underwent a left nephrectomy, and a histopathological examination confirmed the diagnosis and highlighted the distinctive morphological features of this rare entity. Postoperatively, the patient experienced a complete resolution of symptoms. This case underscores the importance of considering myelolipoma in the differential diagnosis of renal masses and highlights the successful management of symptomatic cases through surgical intervention. Awareness of this rare tumor is crucial for accurate diagnosis and appropriate management. Further studies are needed to elucidate the natural history and optimal treatment strategies for renal myelolipomas.
Collapse
Affiliation(s)
- Shakti Sagar
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - K M Hiwale
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pravin Gadkari
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhit Naseri
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Simran Khan
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Miheer M Jagtap
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
3
|
Zhanghuang C, Long N, Yang Z, Xie Y. Bilateral adrenal giant medullary lipoma combined with disorders of sex development: a rare case report and literature review. Front Oncol 2023; 13:1210679. [PMID: 37681022 PMCID: PMC10482419 DOI: 10.3389/fonc.2023.1210679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Bilateral adrenal myelolipoma is rare in clinics and patients with disorders of sex development (DSDs). One case was reported in our center. A 45-year-old patient was admitted to the hospital after discovering a left abdominal mass for more than a year and worsening abdominal pain for 18 days. An imaging examination showed bilateral adrenal masses. Physical examination showed clitoris hypertrophy with patelliform changes, thick and dense pubic hair, normal development of bilateral labia majora without labia minora, and urethral opening. After the relevant preoperative examinations, bilateral adrenal mass resection was performed under general anesthesia. The postoperative pathology confirmed adrenal myelolipoma. The incision healed well without recurrence over 10 years after the operation. Her enlarged clitoris decreased in size. This case report has a detailed diagnosis and treatment process and sufficient examination results. It can provide a reference for diagnosing and treating patients with bilateral adrenal myelolipoma and DSD and reduce the risk of misdiagnosis and mistreatment.
Collapse
Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
- Yunnan Key Laboratory of Children’s Major Disease Research, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming Children’s Hospital, Kunming, China
| | - Na Long
- Special Ward, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children’s Hospital, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children’s Hospital, Kunming, China
- Department of Pathology, The Second People’s Hospital of Yunnan Province, Kunming, China
| |
Collapse
|
4
|
Inoue T, Todaka M, Nakazono Y, Fukata Y, Shin T. A case of adrenal myelolipoma complicated with Prader-Willi syndrome. IJU Case Rep 2023; 6:235-238. [PMID: 37405031 PMCID: PMC10315240 DOI: 10.1002/iju5.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/22/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Prader-Willi syndrome is a congenital disorder that occurs in one in 10 000-30 000 children and is characterized by obesity, short stature, and intellectual disability. Case presentation A 24-year-old male patient with Prader-Willi syndrome presented with an enlarged adrenal tumor. Computed tomography detected a well-defined mass. Magnetic resonance imaging revealed an increased signal intensity predominantly in fatty areas, suggesting adrenal myelolipoma. Laparoscopic left adrenalectomy was performed. Postoperatively, the patient developed mild pulmonary atelectasis, myelolipoma was confirmed by histopathology, and there was no recurrence at approximately 2 years postoperatively. Conclusion This is the first report of Prader-Willi syndrome complicated with adrenal myelolipoma, which was removed laparoscopically.
Collapse
Affiliation(s)
- Toru Inoue
- Department of Urology, Faculty of MedicineOita UniversityYufu‐CityOitaJapan
- Department of Urology, Beppu Medical CenterNational Hospital OrganizationBeppuOitaJapan
| | - Masahiro Todaka
- Department of Urology, Beppu Medical CenterNational Hospital OrganizationBeppuOitaJapan
| | - Yuichi Nakazono
- Department of PathologyBeppu Medical Center, National Hospital OrganizationBeppuOitaJapan
| | - Yoko Fukata
- Department of Diabetes and EndocrinologyBeppu Medical Center, National Hospital OrganizationBeppuOitaJapan
| | - Toshitaka Shin
- Department of Urology, Faculty of MedicineOita UniversityYufu‐CityOitaJapan
| |
Collapse
|
5
|
Solanki S, Badwal S, Nundy S, Mehta NN. Cystic lesions of the adrenal gland. BMJ Case Rep 2023; 16:16/5/e254535. [PMID: 37142280 PMCID: PMC10163428 DOI: 10.1136/bcr-2022-254535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Cystic lesions of the adrenal glands are relatively uncommon and most of them are clinically silent. Though rarely associated with malignant changes, they may carry clinically detrimental consequences if misdiagnosed. Cystic adrenal lesions exhibit a broad histomorphological spectrum, ranging from pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. Here we present the case of a young woman with left-sided abdominal pain and contrast-enhanced CT showing a 10.4×7.7×7.8 cm fluid-filled left suprarenal lesion. The patient underwent exploratory laparotomy with cyst excision, and the histopathological examination of the specimen revealed a pseudocyst of the left adrenal gland. Despite being rare, usually benign and asymptomatic, the diagnosis and management of these cystic lesions of the adrenal glands are often unclear. Any functional lesion, potentially malignant lesion or lesion more than 5 cm deserves surgical management, whereas others can be managed conservatively.
Collapse
Affiliation(s)
- Sanket Solanki
- Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Sonia Badwal
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Naimish N Mehta
- Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
6
|
Shrateh ON, Abugharbieh Y, Abbadi K, Maqboul H, Hind A. A rare case of myelolipoma compressing a second-transplanted kidney: A case report and review of the literature. Int J Surg Case Rep 2023; 106:108134. [PMID: 37043901 PMCID: PMC10139956 DOI: 10.1016/j.ijscr.2023.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Myelolipoma is a rare benign neoplasm composed of mature elements of fatty and hematopoietic tissues. In addition to its low incidence, myelolipoma in kidney transplant patients is much rarer, with only a few cases of this entity reported in the literature. CASE PRESENTATION A 37-year-old diabetic patient was admitted to the hospital due to severe left abdominal pain and elevated creatinine levels of 4.4 mg/dl. The patient has a history of two kidney transplantations. The patient was investigated with different modalities of imaging, which revealed a mass adjacent to the renal graft that was suspicious for malignancy. Histopathological assessment of the resected lesion showed findings consistent with myelolipoma. CLINICAL DISCUSSION Although it's uncommon, myelolipoma should be considered in the differential diagnosis of any renal or extra-renal lesion in kidney transplant patients, including those with a history of graft rejection as in our patient. CONCLUSION In light of the rarity of the lesions, we affirm the significance of the clinicians' reporting such cases that they encounter in order to better understand the disease's biological behavior.
Collapse
Affiliation(s)
- Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Khalid Abbadi
- Department of General Surgery, Palestinian Medical Complex, Ramallah, Palestine
| | - Husni Maqboul
- Department of Pathology, Al-Najah University, Nablus, Palestine
| | - Ahmad Hind
- Department of Urology, Palestinian Red Crescent Hospital, Ramallah, Palestine
| |
Collapse
|
7
|
Şensu S, Ege Gül A, Hallaç Keser S, Gürbüz YS, Altıntaş M, Barışık CC, Özdemir Barışık N, Erdoğan N. Clinical and Pathological Features of Adrenal Myelolipoma and Myelolipomatous Metaplasia Cases in Our Hospital Over 13 Years. CYPRUS JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4274/cjms.2022.2022-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Afzal A, Asadbeigi SN, Kamal M, Hassell L, Fung KM. Intramedullary/intraosseous myelolipoma in a patient with pathologic fracture. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-021-00102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intramedullary lipomatous tumors are rare and mostly reported in the metaphysis of the femur, tibia, and fibula. Myelolipomas are very rare tumors composed of adipose tissue and hematopoietic cells commonly reported in adrenal gland. We report the first reported case of intraosseous myelolipoma with a pathologic fracture in a young woman.
Case presentation
Patient is a young woman who carried a diagnosis of systemic lupus erythematosus, antiphospholipid syndrome, and hyperparathyroidism. Radiologic studies were done after the patient reported right lower leg pain lasting for a month. Radiologic examination showed a large osteolytic lesions with pathologic fracture affecting the medial aspect of the proximal tibia with extensive soft tissue calcification. The initial clinical and radiographic suspicion was brown tumor secondary to the hyperparathyroidism. Curettage of the lesion yielded large fragments of mature adipose tissue punctuated by a variable amount of mature hematopoietic cells. The histopathologic features were suggestive of myelolipoma. The overall radiographic and histopathologic features supported a diagnosis of myelolipoma. The diagnosis of intraosseous myelolipoma can be challenging in small samples such as core biopsies.
Conclusions
The differential diagnoses of intraosseous myelolipoma include normal bone marrow, intramedullary hematopoiesis, and other benign lesions. The gold standard diagnosis is histopathologic examination. However, clinical and radiographic features have important roles in the diagnosis of this rare lesion. Due to the rarity of this tumor and lack of formal guidelines for management, the case-to-case basis treatment is recommended.
Collapse
|
10
|
Mahajan A, Agarwal U, Shukla S, Ashtekar R, Padashetty S, Khadtare R, Noronha V, Prabhash K, Vaish R. Now you see me. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Zulia YS, Gopireddy D, Kumar S, Singareddy A, Lall C. A Rare Case of Hemorrhagic Giant Adrenal Myelolipoma: Radiographic and Pathologic Correlation. Cureus 2021; 13:e17353. [PMID: 34567893 PMCID: PMC8452227 DOI: 10.7759/cureus.17353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Myelolipomas are rare benign tumors made up of adipose and hematopoietic tissue that commonly occur in the adrenal glands unilaterally. Spontaneous hemorrhage occurs in < 5% of these tumors, and often present as large masses. A 50-year-old male presented with right flank pain that had been growing increasingly worse over a two-week period. Contrast-enhanced Computed Tomography (CT) revealed a large suprarenal 15-cm mass exerting mass effect on the kidney and liver along with possible hemorrhage. T1 fat saturated and T2 non-fat saturated magnetic resonance imaging (MRI) confirmed the diagnosis of a myelolipoma with hemorrhage. The patient was treated with surgical resection of the mass and the follow-up pathology report confirmed a giant hemorrhagic adrenal myelolipoma. Spontaneous hemorrhage of a large myelolipoma measuring 15 cm is a rare entity and the correct imaging needs to be done in order to carry out the appropriate treatment.
Collapse
Affiliation(s)
- Yanni S Zulia
- Radiology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Dheeraj Gopireddy
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Sindhu Kumar
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - Chandana Lall
- Abdominal Imaging, University of Florida College of Medicine, Jacksonville, USA
| |
Collapse
|
12
|
Anbardar MH, Soleimani N, Nikeghbalian S, Mohebbi M. Adrenocortical adenoma with myelolipomatous metaplasia: a potential diagnostic pitfall: a case report and review of the literature. J Med Case Rep 2021; 15:333. [PMID: 34217375 PMCID: PMC8255017 DOI: 10.1186/s13256-021-02937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adrenal incidentalomas are often found during investigation for another tumor or unrelated problems. Except for adrenal myelolipoma (second most common primary adrenal incidentaloma following adrenocortical adenomas), adrenal lipomatous tumors are uncommon generally and are often described as case reports in the literature. Since the amount of fat is variable, without the help of advanced imaging techniques, some adrenal lipomatous tumors may be misdiagnosed before pathologic examination. Herein, we report a case of adrenal adenoma with myelolipomatous metaplasia that was excised as a periceliac mass in the setting of recurrent pancreatic cyst. Case report A 45-year-old Iranian woman with hypertension and end-stage renal disease presented with recurrence of a pancreatic cyst (previous pathologic report was mucinous cyst adenoma). During exploratory laparotomy, the mentioned pancreatic cyst was tightly attached to the stomach and jejunum. There was also a periceliac round rubbery lesion (firstly diagnosed by endoscopic ultrasound) that was excised for ruling out malignancy. Histologic examination of the periceliac mass was found to be adrenocortical adenoma with foci of myelolipomatous metaplasia. The pancreatic cyst histology was just a pseudocyst. Conclusion Our case highlights the significance of complete evaluation of incidental findings before surgical intervention, even in the setting of another primary tumor. Myelolipoma and myelolipomatous change (metaplasia) are two different entities. Although very similar as to pathogenesis, there are still some differences.
Collapse
Affiliation(s)
- Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Soleimani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Saman Nikeghbalian
- Department of hepatopancreatobiliary and organ transplant surgery, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Mohebbi
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
Agrawal S, Patil A, Singh AG, Ganpule AP, Sabnis RB, Desai MR. Myelolipoma of Kidney: A Rare Extra-Adrenal Tumor in an Unusual Site. Int J Appl Basic Med Res 2021; 11:60-62. [PMID: 33842301 PMCID: PMC8025959 DOI: 10.4103/ijabmr.ijabmr_341_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 12/19/2020] [Indexed: 12/01/2022] Open
Abstract
Myelolipoma of the kidney is a very rare benign disease which is composed of mature adipose tissue admixed with mature hematopoietic elements in varying proportions. The most common location of myelolipoma is in the adrenal glands, but extra-adrenal myelolipomas in other locations such as the retroperitoneum, presacral region, pelvis, and mediastinum has also been reported. In this case report, we present a case of huge extra-adrenal myelolipoma in renal parenchyma which is rare site for its origin. We report a case of extra-adrenal myelolipoma occurring in the left kidney of a 46-year-old Indian man. We describe the radiological and clinicopathologic features of this unusual tumor with a review of the literature. This case is noteworthy because the tumor was very enlarged and its site was unusual. It is generally impossible to distinguish extra-adrenal myelolipoma from other retroperitoneal tumors by radiological imaging given the rarity of tumor more cases need to be reported to elucidate its biological behavior.
Collapse
Affiliation(s)
- Shashank Agrawal
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | | | | | | |
Collapse
|
14
|
Farzaneh T, Ibe I, Zada S. Myelolipoma of renal sinus in a patient with end-stage renal disease: A rare differential diagnosis in renal neoplasms. SAGE Open Med Case Rep 2021; 9:2050313X211004799. [PMID: 33854781 PMCID: PMC8013534 DOI: 10.1177/2050313x211004799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
Myelolipoma is an uncommon benign neoplasm composed of mature adipose tissue and hematopoietic elements. Myelolipoma occurs most frequently in the adrenal gland but occasionally can be seen in extra-adrenal locations such as lung, liver, retroperitoneum, mediastinum, and kidney. We report a case of extra-adrenal myelolipoma presented as a localized asymptomatic mass in the renal sinus of left native kidney of a 60-year-old woman. The patient was being investigated for end-stage renal disease status post renal transplant. Histologic examination of the lesion showed classic features for myelolipoma. Our case illustrates the awareness of this entity in unusual location and the appropriate use of diagnostic modalities to prevent unnecessary surgical interventions particularly in patients with major co-morbidity in the future.
Collapse
Affiliation(s)
- Ted Farzaneh
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Ifegwu Ibe
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Sherehan Zada
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| |
Collapse
|
15
|
Davari P, Lee CY, Lee JTA. A RARE CASE OF RAPIDLY ENLARGING MYELOLIPOMA IN SICKLE CELL DISEASE. AACE Clin Case Rep 2020; 6:e54-e58. [PMID: 33349795 DOI: 10.4158/accr-2019-0402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/17/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Adrenal myelolipoma (AM) is a benign tumor composed of mature fat cells and hemopoietic elements. Most AMs are incidental findings on imaging and clinically asymptomatic. The purpose of this case report is to describe a rare case of AM and explore its clinical manifestations, imaging features, and treatment. Methods In this study, we report a case of a rapidly growing right AM in a patient with uncontrolled hemoglobin sickle cell disease. A 38-year-old male presented to our institution's endocrine surgery clinic for evaluation of an enlarging right adrenal mass. This mass was incidentally found during an abdominal ultrasound performed for transaminitis and thrombocytopenia. Patient was asymptomatic without any abdominal discomfort, back pain, nausea, or vomiting. Results Patient was lost to follow up until 2018. Follow-up computed tomography scan in 2018 showed the right adrenal mass measuring 12.3 cm in greatest dimension with significant macroscopic fat. Given the imaging features, AM was the presumed diagnosis. However, with a medical history of uncontrolled sickle cell disease, extra-medullary hematopoiesis and rapidly growing liposarcoma could not be ruled out. Surgical excision was performed due to size and significant tumor growth. Diagnosis was confirmed with histopathology and revealed myelolipoma. Conclusion Image characteristics can be helpful in diagnosis of AM; however, the appearance of this lesion on computed tomography can be similar to other adrenal gland pathologies such as liposarcoma and mass-forming extramedullary hematopoiesis. Percutaneous needle biopsy may be indicated if the diagnosis remains unclear.
Collapse
|
16
|
Li KY, Wei AL, Li A. Primary hepatic myelolipoma: A case report and review of the literature. World J Clin Cases 2020; 8:4615-4623. [PMID: 33083426 PMCID: PMC7559654 DOI: 10.12998/wjcc.v8.i19.4615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary hepatic myelolipoma is a rare hepatic mesenchymal tumor mixed by adipose tissue and bone marrow, and there is a lack of general guidelines related to its epidemiology and clinical management. CASE SUMMARY A 26-year-old woman was admitted to our department complaining of a newly found tumor on her left lobe of the liver. The tumor was painless and not associated with any systemic or localized compressive symptoms. Serological tests disclosed a slight increase of gamma-glutamyl transpeptidase (70.0 U/L) and total bilirubin (19.2 μmol/L). Ultrasonography showed a mass about 5.0 cm × 5.0 cm in size that was located in the left lobe of the liver and displayed hyperechoic and well-encapsulated characteristics. Surgical resection was applied, and the following histopathological examination observed a variable proportion of myeloid tissues scattering throughout mature fibrotic adipose tissues, in which myeloid, erythroid, and megakaryocytic cells can be found in magnified view. The follow-up did not show any changes 6 mo after surgery. CONCLUSION This case highlights an extremely rare hepatic mesenchymal tumor, the primary hepatic myelolipoma, and discloses the common characteristics behind this disease and gives clinical recommendations.
Collapse
Affiliation(s)
- Ke-Yu Li
- Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ai-Lin Wei
- Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ang Li
- Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
17
|
Paunovic I, Rovcanin B, Jovanovic M, Buzejic M, Dundjerovic D, Zivaljevic V. Ectopic thyroid tissue in adrenal gland, case report and review of literature. Gland Surg 2020; 9:1573-1578. [PMID: 33224833 DOI: 10.21037/gs-20-471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland (ETTAG). Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Here we present a case of 29 years old patient that was laparoscopically operated because of adrenal incidentaloma which showed 28 mm in maximal diameter on MRI. The patient had normal adrenal function. Pathohistological finding confirmed ETTAG. Follicular cells express TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and lack expression of calretinin. This is the 15th such case described in literature. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases ETTAG was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ETTAG must be distinguished from metastatic deposits from thyroid gland carcinoma. Our patient had normal thyroid function, without any nodules in thyroid gland. We report the youngest patient with ectopic thyroid tissue located in the adrenal gland.
Collapse
Affiliation(s)
- Ivan Paunovic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislav Rovcanin
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Jovanovic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Matija Buzejic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Dundjerovic
- Institute for Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Zivaljevic
- Center for Endocrine surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
18
|
Huang Q, Parmer C, Muniraj T, Aslanian HR, Cai G. Fine needle aspiration cytology of peripancreatic myelolipoma. Diagn Cytopathol 2020; 48:491-493. [PMID: 32150351 DOI: 10.1002/dc.24399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/20/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Qunjia Huang
- Department of Pathology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Caitlin Parmer
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Thiruvengadam Muniraj
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Harry R Aslanian
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
19
|
Buzejić M, Odalović B, Zorić G, Rovčanin B, Slijepčević N, Taušanović K, Jovanović M, Vučen D, Stepanović B, Kalezić N, Tošković A, Paunović I, Živaljević V. Incidence of ectopic thyroid tissue in the adrenal gland. PRAXIS MEDICA 2020. [DOI: 10.5937/pramed2004039b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.
Collapse
|
20
|
Sundaram KM, Gaulding J, Gellert LL, Fonseca RB. Development of multiple adrenal myelolipomas after trauma-induced adrenal haemorrhage. BMJ Case Rep 2019; 12:12/12/e232439. [PMID: 31862816 DOI: 10.1136/bcr-2019-232439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal myelolipomas represent a benign neoplasm with known associations with many chronic diseases, 21-hydroxylase deficiency and cancer. However, the aetiology of adrenal myelolipomas remains unknown. Here, we present a case of a patient with image-proven bilateral adrenal haemorrhages caused by trauma with the subsequent development of bilateral adrenal myelolipomas several years later. Resection and pathological analysis of left adrenal gland confirmed the presence of multiple adrenal myelolipomas. Our case strongly suggests that trauma was the inciting event that led to the formation of these lesions.
Collapse
Affiliation(s)
- Karthik M Sundaram
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology, Stanford University, Stanford, California, USA
| | - James Gaulding
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lan Lin Gellert
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo B Fonseca
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
21
|
Fırat C, Eryiğit S, Yener S, Demir T, Bozkurt O, Demir Ö, Tuna B, Yörükoğlu K. Adrenokortikal adenomda myelolipomatöz değişiklikler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.494051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
22
|
A rare case of virilizing adult ectopic adrenal tumor. Urol Case Rep 2019; 27:100907. [PMID: 31467854 PMCID: PMC6713834 DOI: 10.1016/j.eucr.2019.100907] [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: 03/19/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022] Open
Abstract
Ectopic adrenal gland is an atypical medical condition with a prevalence of less than 1%. It occurs due to an abnormal gland development during embryonic life and can be found in different parts of the body. Rarely, these ectopic glands can be hormonally active and present as bulky masses. Herein we report a case of a patient who underwent laparoscopic surgery for a large myelolipoma associated with an androgen producing adenoma in an ectopic adrenal gland.
Collapse
|
23
|
Abbas SH, Goyal G, Yu K, Loo A. An Incidental Finding of Extra-adrenal Myelolipoma in the Upper Abdominal Cavity Attached to Mesentery: A Rare Case. Cureus 2019; 11:e4830. [PMID: 31403017 PMCID: PMC6682341 DOI: 10.7759/cureus.4830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Myelolipoma are tumors of adrenal glands typically found in the adrenal gland, and are comprised of marrow elements and fat. We report a case of an extra adrenal myelolipoma in a 91-year-old patient, who presented to the emergency department with complaints of abdominal pain and shortness of breath. A CT scan of the abdomen and pelvis revealed a mixed attenuation soft tissue mass with admixed fat located within the mesentery inferior to the body of the stomach. A fine needle aspirate of the mass demonstrated a cellular aspirate with maturing trilineage hematopoiesis and mature adipocytes. This case is being presented due to the rarity of extra adrenal myelolipomas.
Collapse
Affiliation(s)
- Syed H Abbas
- Pathology, Monmouth Medical Center, Long Branch, USA
| | - Geetika Goyal
- Pathology, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Livingston, USA
| | - Kate Yu
- Pathology, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Livingston, USA
| | - Abraham Loo
- Pathology, Monmouth Medical Center, Long Branch, USA
| |
Collapse
|
24
|
Diaz-Perez JA, Velez-Torres J, Iakymenko O, Villamizar N, Rosenberg AE. Epithelioid Hemangioendothelioma Arising Within Mediastinal Myelolipoma: A WWTR1-Driven Composite Neoplasm. Int J Surg Pathol 2019; 27:664-668. [PMID: 30942102 DOI: 10.1177/1066896919837611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this article, we describe a case of conventional epithelioid hemangioendothelioma (EHE) arising within an extra-adrenal myelolipoma. This composite neoplasm arose in the mediastinum of a 51-year-old female. The tumor was composed of a large myelolipoma that contained nodules of EHE consisting of CD31-positive epithelioid endothelial cells that grew in solid cords and were enmeshed in a basophilic hyalinized stroma. Both EHE and myelolipoma are characterized genetically by alterations of WWTR1. We demonstrated the expression of CAMTA-1 chimeric protein by immunohistochemistry both in the neoplastic endothelial cells of EHE and some of the endothelial cells lining the blood vessels in the myelolipoma. To the best of our knowledge, this is the first report of a malignant vascular neoplasm arising in association with myelolipoma.
Collapse
Affiliation(s)
- Julio A Diaz-Perez
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jaylou Velez-Torres
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Oleksii Iakymenko
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nestor Villamizar
- 2 Department of Surgery, Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Andrew E Rosenberg
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
25
|
Larose S, Bondaz L, Mermejo LM, Latour M, Prosmanne O, Bourdeau I, Lacroix A. Coexistence of Myelolipoma and Primary Bilateral Macronodular Adrenal Hyperplasia With GIP-Dependent Cushing's Syndrome. Front Endocrinol (Lausanne) 2019; 10:618. [PMID: 31572300 PMCID: PMC6749096 DOI: 10.3389/fendo.2019.00618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction: Adrenal myelolipomas are usually isolated benign adrenal lesions, but can be adjacent to steroid-secreting adrenocortical tumors. We studied the aberrant regulation of cortisol secretion in a 61 year-old woman with combined bilateral myelolipomas and primary bilateral macronodular adrenal hyperplasia (BMAH) causing Cushing's syndrome. Materials and Methods: Cortisol response was measured during in vivo tests that transiently modulated the levels of ligands for potential aberrant receptors, including GIP. Response to medical therapies decreasing GIP was monitored. Expression of ACTH and of GIP receptors were examined in resected adrenal tissues by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). Results: In vivo, cortisol increased in response to mixed meals (+353%), oral 75 g glucose (+71%), GIP infusion (+416%), and hLH IV (+243%). Suppression of GIP by pasireotide improved cortisol secretion but produced hyperglycemia. The left adrenal was predominantly composed of myelolipoma and strands of BMAH, while the right was mainly composed of BMAH with some foci of myelolipoma on pathology. No ACTH was detectable by immunohistochemistry in BMAH or myelolipomas tissue. Ectopic GIP receptor was confirmed by RT-PCR and immunohistochemistry in BMAH tissues but not in the myelolipomas. No germline mutations were identified in the ARMC5 gene of the patient's leucocyte DNA. Conclusion: This is the first report of interspersed myelolipoma and BMAH with GIP-dependent Cushing's syndrome. In contrast with the BMAH tissues, myelolipoma tissue did not express specific GIP receptors. The potential mechanisms responsible for the interspersed growth of those two lesions remain to be identified.
Collapse
Affiliation(s)
- Stéphanie Larose
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Louis Bondaz
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Livia M. Mermejo
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Mathieu Latour
- Department of Pathology, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Odile Prosmanne
- Department of Radiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
- *Correspondence: André Lacroix
| |
Collapse
|
26
|
Chebib I, Jo VY. Application of ancillary studies in soft tissue cytology using a pattern‐based approach. Cancer Cytopathol 2018; 126 Suppl 8:691-710. [DOI: 10.1002/cncy.22030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories Massachusetts General Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
| | - Vickie Y. Jo
- Department of Pathology Brigham and Women’s Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
| |
Collapse
|
27
|
Sethi S, Thakur S, Jacques S, Aoun HD, Tranchida P. Myelolipoma of the Pelvis: A Case Report and Review of Literature. Front Oncol 2018; 8:251. [PMID: 30018883 PMCID: PMC6037825 DOI: 10.3389/fonc.2018.00251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022] Open
Abstract
Myelolipomas are uncommon, benign tumors which typically occur in the adrenal glands and consist of mature adipose tissue and benign hematopoietic components. Myelolipomas can occur outside of the adrenal glands, but the presacral region, retroperitoneum, pelvis, and mediastinum are unusual locations for these tumors. It is important to recognize this entity in these locations since they can attain massive sizes leading to pressure symptoms and need to be differentiated from the malignant tumors like liposarcomas. We present a myelolipoma case in the presacral region. Our case illustrates the clinical approach of these tumors in such unusual locations.
Collapse
Affiliation(s)
- Seema Sethi
- Department of Pathology, University of Michigan and VA Hospital, Ann Arbor, MI, United States
| | - Shivam Thakur
- Touro College of Osteopathic Medicine, Middletown, NY, United States
| | - Suzanne Jacques
- Department of Pathology, Detroit Medical Centre, Wayne State University School of Medicine, Detroit, MI, United States
| | - H D Aoun
- Imaging Division, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Paul Tranchida
- Department of Pathology, Detroit Medical Centre, Wayne State University School of Medicine, Detroit, MI, United States
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Abstract
INTRODUCTION Adrenal myelolipoma is an invariably benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenomas. It is composed of elements of adipose tissue and extramedullary hematopoiesis. Hypotheses on stem cells and hormonal factors have been formulated regarding its pathogenesis that is still obscure. Despite its benign behavior, adrenal myelolipoma is clinically relevant as it might cause significant difficulties in the differential diagnosis of adrenal tumors. METHODS We have reviewed 420 cases reported between 1957 and 2017 on adrenal myelolipoma retrieved from PubMed and Scopus databases and also 20 of our case series to provide a comprehensive analysis of their pathology, epidemiological and clinical features. RESULTS AND CONCLUSIONS The average age for its diagnosis was 51 years, and no gender difference was observed. The average size of tumors was 10.2 cm. Congenital adrenal hyperplasia was associated to 10% of all cases analyzed, while other adrenal hypersecretory disorders (cortisol, aldosterone) were found in 7.5% of cases. Computed tomography and magnetic resonance imaging can be reliably used for its differential diagnosis. If the diagnosis of an adrenal myelolipoma is unambiguous, and no associated symptoms or hormonal activity are established, surgical intervention is usually not necessary.
Collapse
Affiliation(s)
- Ábel Decmann
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Pál Perge
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Miklós Tóth
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Peter Igaz
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary.
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary.
| |
Collapse
|
30
|
Extra-adrenal myelolipoma and extramedullary hematopoiesis: Imaging features of two similar benign fat-containing presacral masses that may mimic liposarcoma. Eur J Radiol 2017; 93:185-194. [DOI: 10.1016/j.ejrad.2017.05.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/26/2017] [Indexed: 12/26/2022]
|
31
|
Liu HP, Chang WY, Chien ST, Hsu CW, Wu YC, Kung WC, Su CM, Liu PH. Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature. BMC Surg 2017. [PMID: 28651560 PMCID: PMC5485648 DOI: 10.1186/s12893-017-0270-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Wen-Yen Chang
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan.
| | - Shan-Tao Chien
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| | - Chin-Wen Hsu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| | - Yu-Chiuan Wu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| | - Wen-Ching Kung
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| | - Chun-Min Su
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| | - Ping-Hung Liu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist, Kaohsiung City, 802, Taiwan
| |
Collapse
|
32
|
Takano H, Takahashi K, Taki K. Myelodysplastic hematopoiesis mimicking the bone marrow in a mediastinal myelolipoma. Clin Case Rep 2017; 5:385-388. [PMID: 28396752 PMCID: PMC5378849 DOI: 10.1002/ccr3.777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/01/2016] [Accepted: 11/27/2016] [Indexed: 11/07/2022] Open
Abstract
Myelolipoma is one of the rare causes of posterior mediastinal tumor. Surgical excision is effective, which differs from the treatment of extramedullary disease usually concomitant with myelodysplastic syndrome. Cytogenetic analysis suggests the bone marrow cell originating myelolipoma.
Collapse
Affiliation(s)
- Hina Takano
- Department of Hematology Japan Red Cross Musashino Hospital Tokyo Japan
| | - Ken Takahashi
- Department of Thoracic Surgery Japan Red Cross Musashino Hospital Tokyo Japan
| | - Kazuhiro Taki
- Department of Pathology Japan Red Cross Musashino Hospital Tokyo Japan
| |
Collapse
|
33
|
Lam AKY. Lipomatous tumours in adrenal gland: WHO updates and clinical implications. Endocr Relat Cancer 2017; 24:R65-R79. [PMID: 28143811 DOI: 10.1530/erc-16-0564] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Adrenal lipomatous tumour is a group of adrenal tumours with a significant component of adipose tissue. According to the current World Health Organization (WHO) classification of tumours of endocrine organs, adrenal myelolipoma is the only entity amongst the group of tumours being described. In the literature, other more recently documented adrenal lipomatous tumours included 24 lipomas, 32 teratomas and 16 angiomyolipomas. Rare fatty tumours of the adrenal gland comprised liposarcoma, hibernoma, adrenocortical tumours with fat component and rare adrenal tumours with fat component. Myelolipoma comprises approximately 3% of primary adrenal tumour. It is noted more commonly in females and in the right adrenal gland. Approximately 40 bilateral myelolipomas were reported. The tumour is most frequently recorded in patients between fifth and seventh decades of life. Adrenal lipomas are often seen in males and in the right adrenal gland. They were commonly noted in patients in the sixth decade of life. The diagnosis could only be possible on examination of the surgically removed specimen. Adrenal teratomas were more common in females and with a bimodal age distribution. Slightly over 60% of the patients with adrenal teratoma are symptomatic. Adrenal angiomyolipomas were often symptomatic, more common in females and in the fifth decades of life. To conclude, adrenal lipomatous tumour is uncommon. They are often benign and non-functional. It is important to recognize the features of this group of lipomatous tumours in the adrenal gland as they are being detected on increasing incidence as a result of the wide-spread use of modern imaging modalities.
Collapse
Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular PathologyMenzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, Australia
| |
Collapse
|
34
|
Jeon HJ, Lee SY. A CASE OF ADRENAL MYELOLIPOMA A PATIENT WITH BREAST CANCER. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:90-95. [PMID: 31149154 DOI: 10.4183/aeb.2017.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Adrenal myelolipoma is a rare benign tumor composed of adipose tissue and hematopoetic elements resembling bone marrow. The majority of myelolipoma do not produce adrenal hormones and are only found as a result of evaluation for another disorder. With the widespread use of non-invasive abdominal imaging for various reason, its incidental detection has become more common. There are a few cases of breast cancer with concomitant adrenal myelolipoma in the literature. Case A 43-year-old woman presented to endocrine clinic due to presurgical assessment of adrenal mass prior breast cancer surgery. Abdominal CT showed a 9 x 8 cm sized, lobulated contour heterogeneous fatty density mass with peripheral calcification in right adrenal gland. Hormonal studies for adrenal incidentaloma revealed: Aldosterone/Renin ratio, 0.70 ([normal range < 30]; normal DHEA-S, 85.0 µg/dL ([normal range, 80 -560 µg/dL]), ACTH 25 pg/mL ([normal range, 10 - 60 pg/mL]), morning serum cortisol 8.9 µg/dL ([normal range, 5 - 12 µg/dL]). In 24-hour urine, there revealed free cortisol 21.6 µg/day ([normal range, 10 - 50 µg/day); metanephrine 0.19 mg/day ([normal range < 0.8 mg/day]); 17-ketosteroid 14.06 mg/day ([normal range, 7 - 20 mg/day]). The hormonal results of adrenal mass revealed as nonfunctioning. The adrenal mass was surgically resected in order to rule out malignancy. Pathology report showed myelolipoma. Conclusion We reported a case of adrenal myelolipoma coexisting with breast cancer where the diagnosis was made incidentally based on radiological features, treated with surgical resection.
Collapse
Affiliation(s)
- H J Jeon
- Chunbguk National University, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| | - S Y Lee
- Hankook General Hospital, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| |
Collapse
|
35
|
Aguilera N, Auerbach A. Extra-adrenal myelolipoma presenting in the spleen: A report of two cases. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
36
|
Wang W, Zou B, Zhu H, Bao Y. Clonal and genetic relationship between individual components of mucoepidermoid carcinoma: X-chromosome inactivation assay and microsatellite analysis. Hum Pathol 2016; 56:114-22. [DOI: 10.1016/j.humpath.2016.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/15/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
|
37
|
Extra-Adrenal Myelolipoma Containing Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature. Case Rep Hematol 2016; 2016:7364951. [PMID: 27119033 PMCID: PMC4828519 DOI: 10.1155/2016/7364951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/03/2016] [Indexed: 12/28/2022] Open
Abstract
Myelolipoma is a benign tumor consisting of mature fat interspersed with hematopoietic elements resembling bone marrow. The vast majority occurs within the adrenal glands, but several cases of extra-adrenal myelolipomas (EAMLs) have been reported. We report a case of a 64-year-old male who presented with complaint of lower abdominal discomfort. CT scan of abdomen and pelvis showed a 6 cm × 5 cm, well-circumscribed, predominantly fatty mass in the presacral region. Histological examination of the pelvic mass revealed a myelolipoma heavily infiltrated by small lymphoid cell aggregates with immunophenotypic features of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). Review of the literature revealed that there is only one published report of SLL/CLL involving a myelolipoma, which was also an extra-adrenal myelolipoma, and, therefore, our case is the second case of a SLL/CLL involving a myelolipoma that is an extra-adrenal myelolipoma. Extra-adrenal myelolipomas seem to the preferred myelolipomas for involvement by SLL/CLL.
Collapse
|
38
|
Chaudhary R, Deshmukh A, Singh K, Biswas R. Is size really a contraindication for laparoscopic resection of giant adrenal myelolipomas? BMJ Case Rep 2016; 2016:bcr-2016-215048. [PMID: 26989118 DOI: 10.1136/bcr-2016-215048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 55-year-old non-diabetic, normotensive man presented with dull aching pain in the left upper abdomen of 2-year duration. He had no significant medical, surgical or family history. Relevant blood tests and chest skiagram were normal. 24 h urinary vanillylmandelic acid levels and serum electrolyte levels were normal. Ultrasonogram and CT findings were suggestive of a 15 × 11 cm giant left adrenal myelolipoma. A left adrenalectomy was performed using a laparoscopic transperitoneal approach employing three ports. Pneumoperitoneum was achieved by this closed method. After successful excision, the internal contents were suctioned and the capsule was retrieved through a 2.5 cm incision. The operating time was 210 min and total blood loss 50-60 mL; no blood transfusions were needed. The patient was discharged on the third postoperative day. Histopathology confirmed an adrenal myelolipoma. The cited case is of the largest adrenal myelolipoma resected entirely using a laparoscopic approach.
Collapse
Affiliation(s)
| | | | - Kulwant Singh
- People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Rakesh Biswas
- LN Medical College and Research Centre, Bhopal, Madhya Pradesh, India
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
İflazoğlu N, Üreyen O, Keleş M. Extra-adrenal myelolipoma with hemolytic anemia. Turk J Surg 2015; 33:116-118. [PMID: 28740963 DOI: 10.5152/ucd.2015.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 12/21/2014] [Indexed: 11/22/2022]
Abstract
Myelolipomas are rare benign tumors often detected as adrenal masses. Extra-adrenal myelolipomas are encountered even more rarely. The rate of detection of these lesions is increasing with improved radiological techniques. Because of their localization and morphological similarities to well differentiated liposarcomas, extra-adrenal myelolipomas need to be differentiated from other aggressive neoplasms. Preoperative imaging and percutaneous biopsy are important tools in the diagnosis of these lesions. We report a very rare case of an extra-adrenal perirenal myelolipoma associated with hemolytic anemia. The etiology, differential diagnosis, and treatment options for the lesion have been discussed. Fat-containing tumors of the retroperitoneum should be considered in the differential diagnosis. Accurate diagnosis is important to avoid over-treatment of these benign lesions.
Collapse
Affiliation(s)
- Nidal İflazoğlu
- Clinic of General Surgery, Kilis State Hospital, Kilis, Turkey
| | - Orhan Üreyen
- Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mahir Keleş
- Clinic of Internal Medicine, Kilis State Hospital, Kilis, Turkey
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Abstract
Adrenal myelolipomas (AMLs) are rare, benign neoplasms of the adrenal gland with varied clinical presentations. The rarity of these tumors precludes any case-controlled or randomized study into their management. The available literature is limited to case reports and short series from referral centers. This review is an effort to put the available literature into perspective such that clinical decision making can be done with some clarity. The PubMed and Cochrane databases were searched with key words Adrenal Myelolipoma, Adrenal Incidentaloma (AI) and Adrenal Collision Tumor (ACT). From over 1300 search results, 547 relevant publications dating from 1954 to 2014 were reviewed. Details of about 1231 AMLs in the indexed literature were analyzed. Increasing usage of imaging studies has significantly increased the discovery of AMLs. Although AMLs are benign tumors, those measuring larger than 6 cm are prone to rupture and hemorrhage. Thorough endocrine work-up may benefit a selected group of patients, especially those who are hypertensive, diabetic/pre-diabetic, young patients (<50 years) and those with bilateral AML. Regular observation is needed for AML patients who are being treated non-operatively, as many of them may require surgery during follow-up. Although the AACE/AAES guidelines for AI (2009) exclude AML from mandatory metabolic work-up for a newly discovered AI, we feel that a significant number of patients with AML would benefit from metabolic work-up. In the literature, endocrine dysfunction in AML is 7% as compared with 11% in AI. Endocrine dysfunction in AML is probably underdiagnosed.
Collapse
Affiliation(s)
- Vasanth G Shenoy
- Department of Urology, Dr. B.R. Ambedkar Medical College, Bangalore, Karnataka, India
| | - Anuroop Thota
- Department of Urology, Dr. B.R. Ambedkar Medical College, Bangalore, Karnataka, India
| | - Ravi Shankar
- Department of Urology, Dr. B.R. Ambedkar Medical College, Bangalore, Karnataka, India
| | - Mallikarjun G Desai
- Department of Urology, Dr. B.R. Ambedkar Medical College, Bangalore, Karnataka, India
| |
Collapse
|
43
|
Multidisciplinary diagnostic approach combining fine needle aspiration, core needle biopsy and imaging features of a presacral myelolipoma in a patient with concurrent breast cancer. Pathol Res Pract 2015; 211:261-3. [DOI: 10.1016/j.prp.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/04/2014] [Accepted: 12/05/2014] [Indexed: 11/22/2022]
|
44
|
Abstract
Adipocytic tumors are the most common mesenchymal neoplasms, liposarcoma accounting for approximately 20% of soft tissue sarcomas. The differential diagnosis between benign and malignant tumors is often problematic and represents a significant proportion of consultation cases. The goal of this article is to review liposarcoma subtypes, the main benign adipocytic neoplasms: lipoblastoma, hibernoma, spindle/pleomorphic cell lipoma, chondroid lipoma, as well as non adipocytic neoplasms with a lipomatous component such as lipomatous solitary fibrous tumor, emphasizing on practical differential diagnosis issues, and immunohistochemical and molecular tools allowing their resolution.
Collapse
Affiliation(s)
- Nathalie Stock
- Service d'anatomie et cytologie pathologiques, pôle cellules et tissus, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| |
Collapse
|
45
|
Wang J, Fisher C, Thway K. “Dominant” Myelolipoma Encasing Adrenal Cortical Carcinoma. Int J Surg Pathol 2014; 22:731-735. [DOI: 10.1177/1066896914532538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Although myelolipomas of the adrenal glands are detected with increasing frequency with advances in imaging, the occurrence of myelolipoma with adrenal cortical carcinoma remains very rare. We present a case of combined myelolipoma with adrenal cortical carcinoma in a 47-year-old man. In previously reported cases of adrenal cortical carcinoma and myelolipoma, the latter occurred as incidental foci within or peripheral to the carcinoma, perhaps representing “myelolipomatous metaplasia” rather than true neoplasia. We describe a new finding, in which the myelolipomatous component consisted of a large mass adjacent and dominant to the carcinoma. The presence of these 2 defined and apparently independent tumors suggests, in this case, the occurrence of collision or synchronous neoplastic events, rather than of metaplasia.
Collapse
|
46
|
Affiliation(s)
- Jolanta Gourmaud
- Department of Clinical Pathology, Geneva University Hospital, 1 rue Michel-Servet, 1211, Genève 14, Switzerland
| | | | | | | |
Collapse
|
47
|
Joy PS, Marak CP, Nashed NS, Guddati AK. Giant adrenal myelolipoma masquerading as heart failure. Case Rep Oncol 2014; 7:182-7. [PMID: 24748868 PMCID: PMC3985784 DOI: 10.1159/000360981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging. However, myelolipomas may insidiously grow to large sizes and cause mass effects and hemorrhage. Timely diagnosis and surgical resection are curative and lifesaving.
Collapse
Affiliation(s)
- Parijat S Joy
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, and University of Iowa Carver College of Medicine, Iowa, Iowa., USA
| | - Creticus P Marak
- Division of Pulmonary Medicine, Department of Medicine, Tahlequah City Hospital, Tahlequah, Okla., USA
| | - Nadia S Nashed
- Department of Pathology, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, Pa., USA
| | - Achuta K Guddati
- Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Harvard University, Boston, Mass., USA
| |
Collapse
|
48
|
Mitsui Y, Yasumoto H, Hiraki M, Arichi N, Ishikawa N, Harada Y, Maruyama R, Shiina H. Coordination of bone morphogenetic protein 2 (BMP2) and aberrant canonical Wnt/β-catenin signaling for heterotopic bone formation in adrenal myelolipoma: A case report. Can Urol Assoc J 2014; 8:E104-7. [PMID: 24554972 DOI: 10.5489/cuaj.1610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The precise mechanism of heterotopic ossification caused by several types of tumours is largely unknown. However, recent studies have indicated that bone morphogenetic protein 2 (BMP2) is closely linked to the Wnt/β-catenin signaling pathway in this rare phenomenon of bone formation. We report a rare case of adrenal myelolipoma (ML) in a 27-year-old woman with heterotopic bone formation. Immunohistochemical findings showed BMP2 expression in the cytoplasm of tumour cells, as well as the matrix adjacent to newly developed bone tissue. In addition, β-catenin was prominent in the cytoplasm and nuclei of BMP2-positive tumour cells. To the best of our knowledge, this is the first report of adrenal ML showing heterotopic ossification with accelerated expression of both BMP2 and β-catenin. Our case findings indicate that BMP2 overexpression via aberrant canonical Wnt/β-catenin signaling may contribute to heterotopic bone formation occurring in adrenal ML.
Collapse
Affiliation(s)
- Yozo Mitsui
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hiroaki Yasumoto
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Miho Hiraki
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Naoko Arichi
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Noriyoshi Ishikawa
- Department of Pathology (Organ Pathology Unit), Shimane University Faculty of Medicine, Izumo, Japan
| | - Yuji Harada
- Department of Pathology (Organ Pathology Unit), Shimane University Faculty of Medicine, Izumo, Japan
| | - Riruke Maruyama
- Department of Pathology (Organ Pathology Unit), Shimane University Faculty of Medicine, Izumo, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| |
Collapse
|
49
|
Abstract
Myelolipoma is an uncommon benign tumour composed of mature fat tissue and haematopoietic elements and is most commonly found in the adrenal gland. We report a case, which was discovered incidentally on chest X-ray, of a rare occurrence of multifocal extra-adrenal myelolipoma in the thoracic paravertebral region. This was further investigated with multi-detector computed tomography and magnetic resonance imaging. The presumed diagnosis, of extra-adrenal myelolipoma, was histologically confirmed via tissue sample obtained by computed tomography guided biopsy. We compare the adrenal and extra-adrenal entities from the perspective of published literature and also review the cases, published in Pubmed, of extra-adrenal myelolipomas in order to summarize the different locations of this lesion.
Collapse
Affiliation(s)
- Arsany Hakim
- Department of Radiology, Loerrach district hospital, Loerrach, Germany
| | - Christoph Rozeik
- Department of Radiology, Loerrach district hospital, Loerrach, Germany
| |
Collapse
|
50
|
Abstract
An 8-year-old Scottish terrier was presented with a red and painful right eye. Slitlamp biomicroscopy and ocular ultrasound demonstrated the presence of a large mass in the anterior chamber. Enucleation was performed one week after initial presentation. Histological examination of the eye revealed a relatively well-delineated mass distorting the dorsal iris and occupying most of the anterior chamber. The tumor was composed of fully differentiated adipose tissue and normal hematopoietic cells of the three major blood-forming elements. These findings were most consistent with the diagnosis of an anterior chamber myelolipoma distorting the iris. To the author's knowledge, this is the first report of an intraocular myelolipoma in any species.
Collapse
Affiliation(s)
- Goedele Storms
- Veterinary Practice Kleidal, Kleidaallaan 74, Hemiksem, Belgium.
| | | |
Collapse
|