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Almutairi WM, Alshamrani N, Alibrahim AR. Coexistence of Bilateral Giant Adrenal Myelolipomas and Congenital Adrenal Hyperplasia: A Case Report. Cureus 2023; 15:e47266. [PMID: 38021675 PMCID: PMC10655769 DOI: 10.7759/cureus.47266] [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] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Adrenal myelolipomas (AMs) are rare and benign neoplasms, consisting of adipose and mature hematopoietic tissue. They are commonly discovered incidentally with increased use of radiologic imaging. A small number of giant bilateral adrenal masses are reported, particularly in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 36-year-old male with a history of CAH on steroids since childhood, self-discontinued shortly after diagnosis, presenting mainly with abdominal distension and pain besides infertility. Imaging revealed giant bilateral adrenal masses. Subsequently, he underwent bilateral adrenalectomy, and the surgical pathology report revealed myelolipomas measuring 39×17×8 cm on the left and weighing 4050 grams and 28×16×5 cm on the right and weighing 1702 grams. AMs are found to coexist with many other conditions such as Cushing's syndrome, pheochromocytoma, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as a stimulator leading to myelolipomas. This case report highlights the proper history taking and biochemical evaluation for early detection and intervention to avoid catastrophic consequences.
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Affiliation(s)
- Waleed M Almutairi
- Endocrinology and Metabolism, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Nouf Alshamrani
- Endocrinology and Metabolism, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Ahmed R Alibrahim
- Endocrinology and Metabolism, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Steka X, Martens F, Renzulli MM, Hauswirth F, Vrugt B, Renzulli P. Adrenal myelolipoma: Defining the role of surgery. A case report. Int J Surg Case Rep 2022; 98:107527. [PMID: 36030765 PMCID: PMC9434030 DOI: 10.1016/j.ijscr.2022.107527] [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: 06/19/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Adrenal myelolipomas (AMLs) are rare, non-functional, benign tumours mostly diagnosed incidentally. They present as small and unilateral masses that are histologically composed of mature adipose tissue with admixed haemopoietic elements. In a small percentage of patients, pressure symptoms, retroperitoneal haemorrhage or tumour rupture may occur. However, indications for surgery in the majority of asymptomatic patients are poorly defined. Case presentation A 44-year old male patient presented with signs of gastroenteritis. Computed tomography (CT) imaging revealed an encapsulated, sharply delineated mass measuring 87 × 76 × 87 mm displacing the right adrenal gland. Average attenuation was −30 Hounsfield units. Given the pathognomonic features, an AML was suspected. The patient underwent open tumour resection and the diagnosis was histologically confirmed. Clinical discussion Small (<4 cm), homogeneous, non-hormone secreting incidentalomas with an attenuation of <10 Hounsfield units on non-contrast CT are considered benign requiring neither treatment nor follow-up. Giant AMLs (>10 cm) may cause symptoms or complications and are therefore considered candidates for surgery. The treatment strategy of asymptomatic AMLs ranging from 4 cm to 10 cm, however, is controversial and poorly defined. The role of surgery in this specific subgroup of patients is studied. Conclusion Surgery is indicated in the presence of a tumour diameter above 6 cm, rapid tumour growth (RECIST 1.1 criteria for progressive disease at 6–12 months follow-up), imaging suspicious of malignancy, radiological signs of local invasion, functioning ipsilateral adrenocortical adenoma, pressure-related symptoms and signs of retroperitoneal bleeding or spontaneous tumour rupture. Adrenal myelolipoma are rare, non-functional, usually small, benign tumours. They are composed of mature adipose tissue and haemopoietic elements. 95 % of adrenal myelolipomas are asymptomatic and discovered as incidentalomas. The role of surgery in the treatment of mid-sized lesions (4–6 cm) is poorly defined. The present study states the indications for surgery of mid-sized lesions (4–6 cm).
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Wang X, Li X, Cai H, Xiao W, Su P, Huang X, Luo X, Zhang N, Fu N. Rare Primary Adrenal Tumor: A Case Report of Teratomas and Literatures Review. Front Oncol 2022; 12:830003. [PMID: 35615154 PMCID: PMC9124792 DOI: 10.3389/fonc.2022.830003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
Teratomas are very rare, originating from embryonal germ layers. The majority of them are mature, most common in the gonads, and with only 15% out of gonads. In particular, primary adrenal teratomas are extremely rare. The present study reported a case of a young female patient with right adrenal tumor who underwent intermittent pain in the right waist and abdomen and whose CT of adrenal gland showed an 88 mm × 79 mm × 69 mm mass. Besides, her adrenal gland-related hormones are not abnormal. Laparoscopic adrenal tumor resection was performed on her and the histopathological results confirmed that the mass was mature adrenal teratomas. As a newly diagnosed case, strict and regular follow-up is needed, and it is also necessary to detect her AFP and check her adrenal CT in the future. In addition, we have reviewed the literature from 1952 to the present, and a total of 49 cases of adrenal teratoma have been identified and analyzed.
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Affiliation(s)
- Xiaomin Wang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoguang Li
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongjia Cai
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Xiao
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Peng Su
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiang Huang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xu Luo
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Neng Zhang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Neng Zhang, ; Ni Fu,
| | - Ni Fu
- Department of Urology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Neng Zhang, ; Ni Fu,
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Calissendorff J, Juhlin CC, Sundin A, Bancos I, Falhammar H. Adrenal myelolipomas. Lancet Diabetes Endocrinol 2021; 9:767-775. [PMID: 34450092 PMCID: PMC8851410 DOI: 10.1016/s2213-8587(21)00178-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Adrenal myelolipomas are benign, lipomatous tumours with elements of myeloid cells, most of which present as adrenal incidentalomas and comprise 3·3-6·5% of all adrenal masses. Adrenal myelolipomas are usually unilateral (in 95% of cases), variable in size, most often found during midlife, and affect both sexes almost equally. On imaging, adrenal myelolipomas show pathognomonic imaging features consistent with the presence of macroscopic fat. Large adrenal myelolipomas can cause symptoms of mass effect, and can occasionally be complicated by haemorrhage. In the event of a concomitant adrenal cortical adenoma or hyperplasia, adrenal hormone excess might be detected in patients with adrenal myelolipoma. Patients with congenital adrenal hyperplasia exhibit a higher prevalence of adrenal myelolipomas than other patient groups, and are at risk of developing large and bilateral lesions. This Review discusses the pathogenesis, clinical presentation, and management of adrenal myelolipomas.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Carl Christofer Juhlin
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sundin
- Department of Surgical Sciences, Radiology and Molecular Imaging, Uppsala University, Uppsala, Sweden
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Adrenal lipoma: A case report and literature review. Urol Case Rep 2020; 34:101506. [PMID: 33299800 PMCID: PMC7702003 DOI: 10.1016/j.eucr.2020.101506] [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: 10/22/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
The study reports a case of a 57-year-old female patient with incidental right adrenal lipoma (LA). The tumor was detected by ultrasound (US) and confirmed by computed tomography (CT). Due to the size of the mass, it was decided to perform a laparoscopic adrenalectomy. During the differential microscopic diagnosis, were considered adrenal lipomatous tumors, myelolipoma, angiomyolipoma and teratomas, among others. In all these neoplasms, LA is a rare tumor, with only 24 cases reported in the anglo-saxon literature revised. It is a benign adrenal gland tumor with generally asymptomatic and non-functioning nature.
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Abstract
Liposarcoma is a common soft tissue sarcoma in retroperitoneum, but adrenal liposarcoma is rare. We here described a 61-year-old man with left-upper-quadrant pain, hypertension, and weight loss. Abdominal CT showed a large, heterogeneously enhanced mass on the left adrenal area, which compressed the surrounding pancreas, spleen, and left kidney. Subsequent FDG PET/CT demonstrated heterogeneous uptake by the lesion. Postoperative pathological findings confirmed the diagnosis of adrenal liposarcoma.
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Hamidi O, Raman R, Lazik N, Iniguez-Ariza N, McKenzie TJ, Lyden ML, Thompson GB, Dy BM, Young WF, Bancos I. Clinical course of adrenal myelolipoma: A long-term longitudinal follow-up study. Clin Endocrinol (Oxf) 2020; 93:11-18. [PMID: 32275787 PMCID: PMC7292791 DOI: 10.1111/cen.14188] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. DESIGN A retrospective study. PATIENTS Consecutive patients with myelolipoma. RESULTS A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P < .0001), cause mass effect symptoms (32% vs 0%, P < .0001), have haemorrhagic changes (14% vs 1%, P < .0001) and undergo adrenalectomy (52% vs 5%, P < .0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (-10, 115) and median growth rate was 0 mm/y (-6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P = .02), haemorrhagic changes (12% vs 2%, P = .007) and adrenalectomy (35% vs 8%, P < .0001). CONCLUSIONS Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
| | - Ram Raman
- Department of Medicine, Charles University, Prague, Czech Republic
| | - Natalia Lazik
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole Iniguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Benzon M. Dy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - William F. Young
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
| | - Irina Bancos
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
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Yang Y, Hu J, Zhang J, Wang F, He C, Yang Y, Lian J, Zhang T, Liu H. Angiomyolipoma of the adrenal gland: clinical experience and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:654. [PMID: 32566591 PMCID: PMC7290629 DOI: 10.21037/atm-20-3147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Angiomyolipomas, a type of benign mesenchymal tumor originating from perivascular epithelioid cells, are composed of mature adipose tissue, smooth muscle, and thick-walled vessels. With fewer than 20 cases reported in English literature, adrenal angiomyolipoma is extremely rare. In these cases, the patient is usually asymptomatic and the tumor is found incidentally. Adrenal angiomyolipoma has never been reported in association with lung cancer. A 62-year-old man presented with an enlarged mass in the left adrenal gland. The mass had persisted for two years previously and was first discovered during a routine follow-up CT examination after lung cancer resection in 2016. Subsequently, partial left adrenal resection was performed. Postoperative histopathology confirmed a benign angiomyolipoma comprising adipose tissue, blood vessels, and smooth muscle cells. At three months follow-up, the patient was alive and had experienced no recurrence after the operation. Eighteen cases were identified on literature review, among which no patients had a history of lung cancer. These cases occurred more often in females and lesions mostly located on the right side. All of the reported cases were nonfunctional, ranging in size from 0.2 to 16 cm (95% of the masses exceeding 4 cm). In this case report, we consider a rare case of a patient with an adrenal angiomyolipoma with a history of lung cancer. Adrenal angiomyolipoma should be considered as one of the differential diagnoses of adrenal metastasis for patients with a history of primary tumors.
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Affiliation(s)
- Yang Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jie Hu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jingjing Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Fuqin Wang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Cheng He
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yanli Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jie Lian
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Tijiang Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
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Alkhalifa AM, Aldossary MY, Abusultan AJ, AlQattan AS, Alsomali M, Alquraish F, Alkhaldi N, Alsaeed JY, Alwosaibei AM, Alqambar M, Alsaif OH. Lipomatous tumors of adrenal gland: A case series of 5 patients and review of the literature. Int J Surg Case Rep 2020; 67:54-61. [PMID: 32007865 PMCID: PMC7000441 DOI: 10.1016/j.ijscr.2020.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Lipomatous tumors of the adrenal glands are a diverse group of tumors characterized by the composition of adipose tissue. This group of tumors include myelolipomas, angiomyolipomas (AML), lipomas, and teratomas. They are usually benign, non-functioning tumors, and they account for 5% of all primary adrenal tumors. This study aimed to elucidate the management of the initial size of the adrenal mass and symptoms of presentation. We provide a succinct literature review regarding angiomyolipomas tumors of the adrenal glands. PRESENTATION OF CASES Here, we report 5 cases of lipomatous tumors of the adrenal glands. All 5 tumors were non-functioning. Four of them were myelolipoma, and one was AML. Two cases of myelolipoma presented with flank pain, while the rest of the 3 cases presented with hypochondrium pain. Three cases of myelolipoma were managed with laparoscopic adrenalectomy, one case of myelolipoma was converted from laparoscopic to open adrenalectomy because of abdominal adhesions, and the last case was AML and was managed with open adrenalectomy. All patients had an uneventful recovery with regular follow-up. DISCUSSION Myelolipoma, the most common lipomatous tumor of the adrenal gland, consists of a mixture of bone morrow element and adipose tissue. AML consists of a mixture of a thick-walled blood vessel, smooth muscle, and adipose tissue. They mimic many different benign and malignant tumors on radiography, and the histopathological examination is still needed to confirm the diagnosis. There is still controversy in the management of these tumors. Usually, the management is individualized on each case. Reporting of these tumors are increasing due the wide-spread use of modern imaging modalities. CONCLUSION Adrenal lipomatous tumors are uncommon but with the increase use of imaging modalities their detection has increased. Further studies are needed to establish guidelines in the management of these tumors, especially that they can mimic malignant conditions.
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Affiliation(s)
| | - Mohammed Yousef Aldossary
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
| | - Ammar Jamal Abusultan
- Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Al-Khobar, Dammam 31441, Saudi Arabia
| | - Abdullah Saleh AlQattan
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed Alsomali
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Fatimah Alquraish
- Department of General Surgery, King Abdulaziz Airbase Armed Forces Hospital, Dhahran, Saudi Arabia
| | - Njoud Alkhaldi
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Jamal Y Alsaeed
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Abdulaziz M Alwosaibei
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed Alqambar
- Department of Internal Medicine, Endocrine Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Osama Habib Alsaif
- Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia
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Ban A, Satapara J, Rathod K, Bahri N. Teratoma involving adrenal gland - A case report and review of literature. Indian J Radiol Imaging 2019; 29:472-476. [PMID: 31949356 PMCID: PMC6958897 DOI: 10.4103/ijri.ijri_452_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/26/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
Teratomas are germ cell tumors which are mainly gonadal in origin. Other common extra-gonadal sites are mediastinal, sacro-coccygeal and pineal regions. Adrenal teratomas are extremely rare and primary adrenal teratomas are even rarer. We reported a case of primary adrenal teratoma in a 60-year-old male. We reviewed literature from 2000 to till date, and found 29 adult cases and 6 paediatric cases of adrenal teratoma. Usually, they are asymptomatic and identified as an incidental finding. Imaging modality such as USG, CT and MRI are useful in diagnosis. Though these tumors are mostly benign, malignant transformation may occur. Treatment includes surgical removal.
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Affiliation(s)
- Amit Ban
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Jay Satapara
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Ketan Rathod
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Nandini Bahri
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
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Cochetti G, Paladini A, Boni A, Silvi E, Tiezzi A, De Vermandois JAR, Mearini E. Robotic treatment of giant adrenal myelolipoma: A case report and review of the literature. Mol Clin Oncol 2019; 10:492-496. [PMID: 31007910 PMCID: PMC6467000 DOI: 10.3892/mco.2019.1823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Adrenal myelolipoma is a rare mesenchymal tumour with benign biological behaviour that is mainly composed of mature adipose and myeloid tissue. Both sexes are equally affected, most commonly between the fifth and seventh decades of life. The diagnosis of adrenal myelolipoma is mostly incidental. Although it may occasionally be associated with necrosis, rupture and haemorrhage, causing abdominal pain, this tumour is usually asymptomatic. Consequently, management is conservative, while surgical treatment is reserved for symptomatic cases, or for masses growing quickly or to a size >6 cm. Giant myelolipomas (sized >10 cm) are rare. Open radical adrenalectomy is the standard treatment for giant myelolipomas, while the minimally invasive approach has been used in only few cases. We herein report the case of a patient with a giant adrenal myelolipoma who underwent robotic partial adrenalectomy. To the best of our knowledge, this is the largest giant adrenal myelolipoma treated with robotic surgery reported in the literature to date. A 55-year-old male patient underwent an abdominal computed tomography scan during follow-up after radical prostatectomy for prostate cancer Gleason Score 6 (ISUP 1) due to biochemical recurrence. The examination revealed a right hypodense adrenal mass, sized 16×13 cm. Abdominal magnetic resonance imaging confirmed the presence of characteristics suggestive of a myelolipoma. The patient did not report any symptoms. Due to the benign characteristics of the mass, robotic partial adrenalectomy and enucleation of the mass were performed. The operative time and estimated blood loss were 205 min and 100 ml, respectively. No intra- or postoperative complications occurred. The patient was mobilized on the first postoperative day and the time to flatus was 36 h; the length of hospitalization was 4 days. Histological examination confirmed the diagnosis of adrenal myelolipoma, sized 18×11.5×6 cm. No tumour recurrence occurred over a follow-up period of 12 months. In conclusion, robotic surgery allows performing partial adrenalectomy with a lower risk of bleeding and with preservation of healthy adrenal tissue, which is of paramount importance for the patient as it reduces recovery time and the need for medical substitution therapy.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Elisa Silvi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alberto Tiezzi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
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12
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Lin CY, Levy D, Higgins JPT, Kunder CA, Kao CS. Adrenal Myelolipomas Involved by Plasma Cell Myeloma. Am J Clin Pathol 2018; 150:406-414. [PMID: 30052719 DOI: 10.1093/ajcp/aqy068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To report the presence and evaluate the frequency of plasma cell neoplasms within adrenal myelolipomas. METHODS Adrenal myelolipomas within our institution were reviewed for the presence of hematologic neoplasia, and a review of the literature was performed. RESULTS Two (9%) of 23 adrenal myelolipomas were involved by plasma cell myeloma. The patients were 71 and 81 years old, one woman and one man, with tumors measuring 7 cm and 8.5 cm, respectively. Both tumors contained large aggregates of dysplastic plasma cells occupying at least one ×10 field and demonstrated light chain restriction. Neither had an established diagnosis of plasma cell neoplasm previously. After receiving therapy, one patient exhibited a stable clinical course 1 year after diagnosis while the other died of disease 3 years later. CONCLUSIONS We report the first two cases of adrenal myelolipoma involved by plasma cell myeloma, a rare and subtle finding that has significant clinical implications.
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Affiliation(s)
- Chieh-Yu Lin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - David Levy
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - John P T Higgins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Christian A Kunder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Chia-Sui Kao
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
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Abstract
The fourth edition of the World Health Organization (WHO) classification of endocrine tumours contains substantial new findings for the adrenal tumours. The tumours are presented in two chapters labelled as "Tumours of the adrenal cortex" and "Tumours of the adrenal medulla and extra-adrenal paraganglia." Tumours of the adrenal cortex are classified as cortical carcinoma, cortical adenoma, sex cord stromal tumours, adenomatoid tumour, mesenchymal and stromal tumours (myelolipoma and schwannoma), haematological tumours, and secondary tumours. Amongst them, schwannoma and haematological tumours are newly documented. The major updates in adrenal cortical lesions are noted in the genetics of the cortical carcinoma and cortical adenoma based on the data from The Cancer Genome Atlas (TCGA). Also, a system for differentiation of oncocytoma from oncocytic cortical carcinoma is adopted. Tumours of the adrenal medulla and extra-adrenal paraganglia comprise pheochromocytoma, paraganglioma (head and neck paraganglioma and sympathetic paraganglioma), neuroblastic tumours (neuroblastoma, nodular ganglioneuroblastoma, intermixed ganglioneuroblastoma, and ganglioneuroma), composite pheochromocytoma, and composite paraganglioma. In this group, neuroblastic tumours are newly included in the classification. The clinical features, histology, associated pathologies, genetics, and predictive factors of pheochromocytoma and paraganglioma are the main changes introduced in this chapter of WHO classification of endocrine tumours. The term "metastatic pheochromocytoma/paraganglioma" is used to replace "malignant pheochromocytoma/paraganglioma." Also, composite pheochromocytoma and composite paraganglioma are now documented in separate sections instead of one. Overall, the new classification incorporated new data on pathology, clinical behaviour, and genetics of the adrenal tumours that are important for current management of patients with these tumours.
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Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular Pathology, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Q4222, Australia.
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14
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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.
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Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular PathologyMenzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, Australia
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15
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Li S, Li H, Ji Z, Yan W, Zhang Y. Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults. Oncol Lett 2015; 10:2865-2870. [PMID: 26722254 DOI: 10.3892/ol.2015.3701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 08/17/2015] [Indexed: 12/17/2022] Open
Abstract
Primary adrenal teratoma is extremely rare. To investigate the clinical characteristics and further enrich the limited knowledge on its diagnosis and treatment, the present study retrospectively analyzed the detailed clinical data of five patients with primary adrenal teratomas treated in the Peking Union Medical College Hospital (Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China) between March 2009 and February 2014. The five patients were female, aged from 16 to 51 years (mean, 36.0±16.3 years), with solitary lesions that were incidentally found on routine physical examinations. The tumor size ranged from 2.4 to 9.0 cm (mean, 6.0±2.7 cm). Ultrasonography revealed a mixed echo in four patients, and computed tomography showed mixed density masses with fat components and calcification in three patients. Adrenal-related endocrine tests were normal in all five patients, and no abnormalities were found in the three patients who underwent somatostatin receptor scintigraphy examination. All patients were treated with retroperitoneal laparoscopic surgery, with no complications, and the resected tumors were identified as mature cystic teratomas pathologically. To date, the patients have been followed up for 4-60 months post-operatively, with no recurrence. In conclusion, this rare adrenal teratoma is an occult entity to which reproductive females are susceptible. The tumor exhibits no typical clinical manifestations or adrenal-related laboratory abnormalities, and the pre-operative diagnosis mainly relies on imaging characteristics of a heterogeneous lesion containing fat components with scattered and marginal calcifications. The preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is good.
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Affiliation(s)
- Shuqiang Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
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16
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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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