1
|
Bapir R, Aghaways I, Yasseen HA, Rashid RJ, Ahmed SF, Mustafa AM, Hama NH, Mohammed HAS, Karim SO, Kakamad FH, Abdalla BA. Laparoscopic resection of giant adrenal myelolipoma: A case report with review of literature. Radiol Case Rep 2024; 19:5078-5083. [PMID: 39253047 PMCID: PMC11381978 DOI: 10.1016/j.radcr.2024.07.072] [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: 06/10/2024] [Accepted: 07/14/2024] [Indexed: 09/11/2024] Open
Abstract
Giant adrenal myelolipoma (AML) may cause severe symptoms. In contrast to the previous reports, laparoscopy may play a pivotal role in the management of giant AML. This report aims to discuss a case of giant AML managed successfully by laparoscopy. A 63-year-old male was found to have a giant (12 × 10 × 8 cm) left AML during a workup for left lower chest pain on imaging. laparoscopic excision of a left adrenal gland with the lesion was performed under general anesthesia. The patient was discharged from the hospital after 3 days uneventfully. AML is a benign tumor that is characterized by the presence of adipose tissue and hematopoietic elements. Myelolipomas are typically asymptomatic. AML diagnosis is based on imaging and blood workup. Small asymptomatic AML is usually managed conservatively, while symptomatic AML is managed with surgery. Even though an open approach is the standard option, laparoscopy, as a minimally invasive technique, in some centers may replace laparotomy. Laparoscopy can be a successful method for managing AML, even when they are large in size.
Collapse
Affiliation(s)
- Rawa Bapir
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Sulaimani Teaching Hospital, Zanko Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Ismaeel Aghaways
- Sulaimani Teaching Hospital, Zanko Street, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Hadeel A Yasseen
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Rezheen J Rashid
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Department of Radiology, Hiwa Hospital, Shorsh Street, Sulaymaniyah, Kurdistan, Iraq
| | - Shaho F Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Ayman M Mustafa
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Nali H Hama
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | | | - Sanaa O Karim
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Nursing, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Berun A Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| |
Collapse
|
2
|
Management of bilateral adrenal myelolipoma without endocrine disorder: About a rare case report. Urol Case Rep 2021; 39:101755. [PMID: 34221899 PMCID: PMC8246241 DOI: 10.1016/j.eucr.2021.101755] [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: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Adrenal gland myelolipomas are benign, hormonally inactive, and mostly asymptomatic and unilateral tumors. However, it could be symptomatic and bilateral in rare cases. The diagnosis is based on a CT scan and a histological study. We present a rare case of a surgically managed bilateral adrenal gland myelolipoma with a giant mass on the left side in a 40-year-old man who presented in our department for atypical abdominal pain. The patient underwent surgical resection of the left adrenal mass. Due to the resolution of the abdominal pain, a close follow-up for the right mass by CT scan was chosen.
Collapse
|
3
|
Zhu GG, Witt BL, Winter III TC, Rogers DM. Multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. BMJ Case Rep 2021; 14:14/2/e239107. [PMID: 33622747 PMCID: PMC7907867 DOI: 10.1136/bcr-2020-239107] [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: 11/03/2022] Open
Abstract
Myelolipomas are benign tumours typically occurring in the adrenal glands, made up of fat and trilineage haematopoeitic cells resembling bone marrow. Their aetiology is not well understood; however, they have a clear association with elevated serum adrenocorticotropic hormone (ACTH). Extra-adrenal myelolipomas are rare, and to our knowledge there are no previously reported cases of multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. We present the case of a patient with an ACTH-producing pituitary adenoma who developed multiple enlarging fat containing lesions in the liver and retroperitoneum, which were histologically proven multifocal myelolipomas.
Collapse
Affiliation(s)
- Grace G Zhu
- Department of Radiology, University of Utah Health, Salt Lake City, UT, USA
| | - Benjamin L Witt
- Department of Anatomical Pathology, University of Utah Health, Salt Lake City, UT, USA
| | | | - Douglas M Rogers
- Department of Radiology, University of Utah Health, Salt Lake City, UT, USA
| |
Collapse
|
4
|
Roger BR, Dhali A, Ramesh RS, Dsouza C. Giant Bilateral Adrenal Myelolipoma: Case Report. Indian J Endocrinol Metab 2020; 24:551-553. [PMID: 33643873 PMCID: PMC7906101 DOI: 10.4103/ijem.ijem_737_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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
Adrenal myelolipomas are nonfunctional tumors that are usually asymptomatic; however, they have been known to coexist with other endocrine disorders, such as Cushing's syndrome, congenital adrenal hyperplasia (CAH), Conn's syndrome, and pheochromocytoma. We report a case of a 49-year-old man with hypertension and diabetes mellitus who complained of chronic abdominal pain, vomiting, and early satiety. Preoperative contrast-enhanced computerized tomography (CECT) was performed, and adrenal myelolipoma was considered, lab investigations revealed a nonfunctional tumor. CECT also revealed bilateral renal cortical cyst, right renal calculi, and hepatic cyst. A left open cortical sparing adrenalectomy was performed, pathological examination confirmed the diagnosis, and a radiological surveillance was planned for the right tumor. Four years following this, the patient came back with a similar presentation. Right adrenalectomy was performed after preoperative workup, and subsequently steroid replacement therapy was initiated. We suggest adequate follow-up of a patient presenting with adrenal myelolipoma and to explore the possibility of establishing a syndromic diagnosis such as autosomal dominant polycystic kidney disease (ADPKD).
Collapse
Affiliation(s)
- B. Rathna Roger
- Department of Surgical Oncology, St. John's Medical College, Bangalore, Karnataka, India
| | - Arkadeep Dhali
- Department of Surgical Oncology, St. John's Medical College, Bangalore, Karnataka, India
| | - Rakesh S. Ramesh
- Department of Surgical Oncology, St. John's Medical College, Bangalore, Karnataka, India
| | - Christopher Dsouza
- Department of Surgical Oncology, St. John's Medical College, Bangalore, Karnataka, India
| |
Collapse
|
5
|
Mhammedi WA, Ouslim H, Ouraghi A, Irzi M, Elhoumaidi A, Elhoumaidi A, Chennoufi M, Mokhtari M, Elmouden A, Barki A. Adrenal myelolipoma: from tumorigenesis to management. Pan Afr Med J 2019; 34:180. [PMID: 32153720 PMCID: PMC7046110 DOI: 10.11604/pamj.2019.34.180.20891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Adrenal myelolipoma (MLS) is a rare, benign and non-functional neoplasm, composed of adipose tissue and myeloid. We report a rare case of adrenal myelolipoma of a 20-year-old female revealed with chronic abdominal pain. Computed tomography (CT) scan of the abdomen guided diagnosis and surgical resection was performed given symptomatic and bulky mass. Histological examination confirmed the diagnosis. At 18 months after the surgery, the patient had no evidence of recurrence. The diagnosis of MLS is radiological. Therapeutic abstention is the rule for a small, asymptomatic tumor. The surgical removal is indicated when it is bulky (exceeds 7cm), symptomatic or hormonal activity.
Collapse
Affiliation(s)
| | - Hicham Ouslim
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Abdelghani Ouraghi
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Mohammed Irzi
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Amine Elhoumaidi
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Amine Elhoumaidi
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Mehdi Chennoufi
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Mohammed Mokhtari
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Anouar Elmouden
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| | - Ali Barki
- Urology Department, Mohammed the Sixth University Hospital, Oujda, Morocco
| |
Collapse
|
6
|
Duque-Díaz E, Alvarez-Ojeda O, Coveñas R. Enkephalins and ACTH in the mammalian nervous system. VITAMINS AND HORMONES 2019; 111:147-193. [PMID: 31421699 DOI: 10.1016/bs.vh.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The pentapeptides methionine-enkephalin and leucine-enkephalin belong to the opioid family of peptides, and the non-opiate peptide adrenocorticotropin hormone (ACTH) to the melanocortin peptide family. Enkephalins/ACTH are derived from pro-enkephalin, pro-dynorphin or pro-opiomelanocortin precursors and, via opioid and melanocortin receptors, are responsible for many biological activities. Enkephalins exhibit the highest affinity for the δ receptor, followed by the μ and κ receptors, whereas ACTH binds to the five subtypes of melanocortin receptor, and is the only member of the melanocortin family of peptides that binds to the melanocortin-receptor 2 (ACTH receptor). Enkephalins/ACTH and their receptors exhibit a widespread anatomical distribution. Enkephalins are involved in analgesia, angiogenesis, blood pressure, embryonic development, emotional behavior, feeding, hypoxia, limbic system modulation, neuroprotection, peristalsis, and wound repair; as well as in hepatoprotective, motor, neuroendocrine and respiratory mechanisms. ACTH plays a role in acetylcholine release, aggressive behavior, blood pressure, bone maintenance, hyperalgesia, feeding, fever, grooming, learning, lipolysis, memory, nerve injury repair, neuroprotection, sexual behavior, sleep, social behavior, tissue growth and stimulates the synthesis and secretion of glucocorticoids. Enkephalins/ACTH are also involved in many pathologies. Enkephalins are implicated in alcoholism, cancer, colitis, depression, heart failure, Huntington's disease, influenza A virus infection, ischemia, multiple sclerosis, and stress. ACTH plays a role in Addison's disease, alcoholism, cancer, Cushing's disease, dermatitis, encephalitis, epilepsy, Graves' disease, Guillain-Barré syndrome, multiple sclerosis, podocytopathies, and stress. In this review, we provide an updated description of the enkephalinergic and ACTH systems.
Collapse
Affiliation(s)
- Ewing Duque-Díaz
- Universidad de Santander UDES, Laboratory of Neurosciences, School of Medicine, Bucaramanga, Colombia.
| | - Olga Alvarez-Ojeda
- Universidad Industrial de Santander, Department of Pathology, School of Medicine, Bucaramanga, Colombia
| | - Rafael Coveñas
- Laboratory of Neuroanatomy of the Peptidergic Systems, Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, Salamanca, Spain
| |
Collapse
|