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Affiliation(s)
| | - Yizhak Kupfer
- Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, New York, USA
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Liu Q, Wang LA, Su J, Tong D, Lan W, Wang L, Liu G, Zhang J, Zhang VW, Zhang D, Chen R, Zhu Q, Jiang J. Giant bilateral adrenal myelolipomas in two Chinese families with congenital adrenal hyperplasia. Endocr Connect 2018; 7:/journals/ec/aop/ec-18-0273.xml. [PMID: 30352423 PMCID: PMC6215793 DOI: 10.1530/ec-18-0273] [Citation(s) in RCA: 2] [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: 07/14/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT AND OBJECTIVES Congenital adrenal hyperplasia (CAH) is one of the most prevalent, and potentially severe, genetic inborn errors of steroid synthesis directly affecting metabolism. Most patients are diagnosed and treated at an early age. There have been very limited reports of adults with CAH-associated adrenal myelolipomas. We aimed to analyze two families with CAH-associated giant adrenal myelolipomas caused by defects in CYP21A2 and CYP17A1 genes. PARTICIPANTS AND METHODS A total of 14 individuals from two unrelated families were identified with either CYP21A2 or CYP17A1 mutations. Of note, 5 patients were found with adrenal myelolipomas. Total DNA isolated from the peripheral blood of the two probands was screened for potential mutations in the following susceptibility genes of CAH: CYP21A2, CYP11B1, CYP17A1, HSD17B3, HSD3B2, ARMC5, and STAR using Target Capture-Based Deep Sequencing; and Sanger sequencing was conducted for the family members to detect the potential mutations. RESULTS In family 1, molecular genetics sequencing revealed a compound heterozygous mutation (c.293-13C>G / c.518T>A, p.I173N) in CYP12A2 in the patient and his brother. In family 2, all three female patients with adrenal myelolipomas were found to have a compound heterozygous mutation (c.1118A>T, p.H373L / c.1459_1467del9, p.D487_F489del) in CYP17A1. CONCLUSION To avoid giant CAH-associated adrenal myelolipomas in adults, it is important to identify CAH early so appropriate treatment can be initiated to interrupt the chronic adrenal hyperstimulation resulting from increased ACTH. Genetic testing and counseling could be useful in CAH.
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Affiliation(s)
- Qiuli Liu
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Lin-ang Wang
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Jian Su
- Department of UrologyAffiliated Hospital of Nanjing University of Traditional Chinese Medical, Nanjing, People’s Republic of China
| | - Dali Tong
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Weihua Lan
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Luofu Wang
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Gaolei Liu
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Jun Zhang
- Department of ObstetricsThird Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Victor Wei Zhang
- Department of Molecular and Human GeneticsBaylor College of Medicine, Houston, Texas, USA
- AmCare Genomics LabGuangzhou, People’s Republic of China
| | - Dianzheng Zhang
- Department of Bio-Medical SciencesPhiladelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Rongrong Chen
- Geneplus-Beijing InstituteBeijing, People’s Republic of China
| | - Qingyi Zhu
- Department of UrologyAffiliated Hospital of Nanjing University of Traditional Chinese Medical, Nanjing, People’s Republic of China
| | - Jun Jiang
- Department of UrologyInstitute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People’s Republic of China
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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.
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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
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Giant bilateral adrenal myelolipoma:Case presentation and a brief literature review. Urol Case Rep 2018; 18:67-69. [PMID: 29785374 PMCID: PMC5958930 DOI: 10.1016/j.eucr.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
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Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma. Case Rep Urol 2015; 2015:635072. [PMID: 26064766 PMCID: PMC4429215 DOI: 10.1155/2015/635072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b) with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma.
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Zattoni D, Balzarotti R, Rosso R. The management of bilateral myelolipoma: Case report and review of the literature. Int J Surg Case Rep 2015; 12:31-6. [PMID: 25989259 PMCID: PMC4485682 DOI: 10.1016/j.ijscr.2015.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Bilateral adrenal myelolipoma is a rare benign neoplasm. We presented the case of a young man affected by a bilateral myelolipoma and the analysis of the literature of bilateral cases of myelolipoma. Our purpose is to give a suggestion of clear terms of reference regarding the management of this kind of bilateral neoplasm. PRESENTATION OF CASE We reported the case of a 41-year-old healthy man complained of abdominal pain in the upper quadrants. No significant alterations were found in routine blood and endocrinological tests. The imaging (CT and MRI) showed a huge right adrenal mass and a smaller lesion at the left adrenal gland. The preoperative pathological characterization was suggestive for a myelolipoma. A right open adrenalectomy was performed, and a radiological surveillance was planned for the left tumor. The pathological exam confirmed the diagnosis. DISCUSSION In literature, there are 36 cases described. The clinical presentation consisted of symptomatic tumors, incidentally diagnosed lesions or myelolipomas in patients with an associated endocrinal disorder. Symptomatic tumors or those bigger than 7cm, because of the potential risk of rupture, are usually treated surgically. In smaller (<7cm) and asymptomatic ones the surgical treatment is not univocal. CONCLUSION In the setting of the surgical treatment, it is important to preserve in some way the hormonal function. For that reason, the bilateral adrenalectomy has to be reserved for symptomatic or sizeable (>7cm) cases. As far as we know, this is the first review on bilateral myelolipomas.
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Affiliation(s)
- Davide Zattoni
- Department of General Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
| | - Ruben Balzarotti
- Department of General Surgery, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Raffaele Rosso
- Chief of Department of General Surgery, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
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Bilateral giant adrenal myelolipomas presenting as an enlarging ventral hernia: Radiologic-pathologic correlation and literature review. Radiol Case Rep 2015. [DOI: 10.2484/rcr.v10i2.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia. Case Rep Surg 2014; 2014:728198. [PMID: 25140269 PMCID: PMC4124659 DOI: 10.1155/2014/728198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 11/18/2022] Open
Abstract
Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-α hydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing's syndrome, Addison's disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.
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Yamashita S, Ito K, Furushima K, Fukushima J, Kameyama S, Harihara Y. Laparoscopic versus open adrenalectomy for adrenal myelolipoma. Ann Med Surg (Lond) 2014; 3:34-8. [PMID: 25568783 PMCID: PMC4268474 DOI: 10.1016/j.amsu.2014.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 12/21/2022] Open
Abstract
Introduction Earlier reports of laparoscopic adrenalectomy (LA) for adrenal myelolipoma are limited. Presentation of case Between June 2000 and September 2012, we performed right adrenal resections using LA and open adrenalectomy (OA) in patients with myelolipoma (n = 3 and n = 3, respectively). Then, we evaluated patients' background characteristics and short- and long-term outcomes for both groups. The median maximum diameters of tumors were 3.5 (3.0–4.4) cm and 7.1 (7.0–9.5) cm for the LA and OA groups, respectively. The median durations of the operation were 152 (117–188) min and 218 (153–230) min, and the median blood loss volumes were 50 (20–160) mL and 290 (62–1237) mL in the LA and OA groups, respectively. The median postoperative lengths of hospital stay were 4 (4–4) days and 11 (11–13) days for the LA and OA groups, respectively. Conversion from LA to an open approach during surgery was not necessary in any of the cases. Additionally, perioperative morbidity and mortality were not observed. Discussion The limitation of this study is its methodological design; it is a case series and not a matched-control study, which would be difficult to conduct owing to the rare nature of adrenal myelolipoma. However, we esteem that LA will become widespread in the future because it is feasible, cosmetic, and less invasive. Conclusion LA was a safe, feasible, and effective approach to adrenal myelolipoma, assisted by advancement in preoperative imaging diagnostic techniques.
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Affiliation(s)
- Suguru Yamashita
- Department of Surgery, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Kei Ito
- Department of Surgery, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Kaoru Furushima
- Department of Surgery, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Junichi Fukushima
- Department of Pathology, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Shuji Kameyama
- Department of Urology, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Yasushi Harihara
- Department of Surgery, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan
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Geng C, Liu N, Yang G, Qi M, Chen W. Primary mediastinal myelolipoma: A case report and review of the literature. Oncol Lett 2012; 5:862-864. [PMID: 23426140 PMCID: PMC3576200 DOI: 10.3892/ol.2012.1085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/11/2012] [Indexed: 11/17/2022] Open
Abstract
Myelolipoma is a rare, benign neoplasm composed of mature adipocytes and hematopoietic tissue, mainly occurring in the adrenal glands. The majority of extra-adrenal myelolipomas have been identified in the presacral region and primary mediastinal myelolipoma is very rare. Computed tomography (CT) and magnetic resonance imaging (MRI) are effective methods to detect myelolipoma, while fine-needle aspiration (FNA) combined pathology is able to definitively rule out malignancy. There is no standard method of treatment for the disease. Small (<4 cm) asymptomatic tumors should be monitored, while symptomatic tumors or large (>7 cm) myelolipomas should be removed by surgery. This study describes a patient who presented with two mediastinal myelolipomas that were not encapsulated and presented as a string-of-pearls-type. The pathological diagnosis was myelolipoma and the patient did not relapse within the three years following resection.
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Affiliation(s)
- Chuanying Geng
- Departments of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Abstract
Adenoma, myelolipoma, phaeochromocytoma, metastases, adrenocortical carcinoma, neuroblastoma, and lymphoma account for the majority of adrenal neoplasms that are encountered in clinical practice. A variety of imaging methods are available for evaluating adrenal lesions including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques such as meta-iodobenzylguanidine (MIBG) scintigraphy and positron-emission tomography (PET). Lipid-sensitive imaging techniques such as unenhanced CT and chemical shift MRI enable detection and characterization of lipid-rich adenomas based on an unenhanced CT attenuation of ≤ 10 HU and signal loss on opposed-phase compared to in-phase T1-weighted images, respectively. In indeterminate cases, an adrenal CT washout study may differentiate adenomas (both lipid-rich and lipid-poor) from other adrenal neoplasms based on an absolute percentage washout of >60% and/or a relative percentage washout of >40%. This is based on the principle that adenomas show rapid contrast washout while most other adrenal neoplasms including malignant tumours show slow contrast washout instead. ¹⁸F-2-fluoro-2-deoxy-d-glucose-PET (¹⁸FDG-PET) imaging may differentiate benign from malignant adrenal neoplasms by demonstrating high tracer uptake in malignant neoplasms based on the increased glucose utilization and metabolic activity found in most of these malignancies. In this review, the multi-modality imaging appearances of adrenal neoplasms are discussed and illustrated. Key imaging findings that facilitate lesion characterization and differentiation are emphasized. Awareness of these imaging findings is essential for improving diagnostic confidence and for reducing misinterpretation errors.
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