INTRODUCTIONMyelolipoma is a rare, benign neoplasm that predominantly occurs in the adrenal gland and is composed of mature adipose tissue and scattered islands of hematopoietic elements. Although usually small and asymptomatic, there are some cases of adrenal myelolipoma that cause symptoms such as chronic pain. Elective surgery can prevent a more severe symptom presentation and life threatening progression while also allowing accurate diagnosis in patients with tumors larger than 6 cm.PRESENTATION OF CASEThis report presents an unusual case of a 28-year-old female who suffered with chronic pain from a growing left-sided adrenal myelolipoma. Without the financial means for additional testing along with many symptoms warranting a high suspicion for malignancy, this patient decided to have the mass surgically excised, which was both diagnostic and curative.DISCUSSIONFor this specific patient, surgery was the most cost effective option, as well as both diagnostic and curative. Surgery can also prevent complications such as spontaneous rupture and hemorrhage of the mass, which can lead to subsequent cardiovascular shock.CONCLUSIONManagement of adrenal myelolipoma should be considered on an individual basis. Although it is a benign tumor, surgery plays an important role for symptomatic cases and those lesions that cannot be distinguished reliably from malignancy.

functioning as expected. In comparison, of the 5 patients with negative patch test results, 3 patients kept their devices, which demonstrated that the negative patch test result had important diagnostic value. The remaining patients had their devices extracted prior to testing, and reimplantation was not indicated.Discussion | This study included 11 patients who underwent cardiac implant patch testing. The majority of patients had history of erythema at the implant site. Concern for infection was common, and more than half of patients had devices extracted prior to presentation. Culture results, with 2 exceptions, were negative.More than half of the patients had relevant positive patch test results, and the most common allergens were metals, rubber accelerators, and silicone. Cardiac device allergy to metals, silicone-based components, and thiuram rubber accelerators has been published previously. 5 To our knowledge, there are previous reports of allergy to carbamate rubber accelerators, diphenylguanidine rubber accelerators, and lidocaine, though not in the setting of cardiac devices. The majority of patients with relevant positive patch test reactions underwent device extraction and successful reimplantation. In a majority of cases, electrophysiologists were able to avoid allergens. For those patients in which we have follow-up data, new cardiac devices were functioning well.One limitation of this study is the lack follow-up data for 2 subjects. In addition, the duration of follow-up was limited to a maximum of 36 months. Cardiac device allergy should be considered when there is clinical concern for infection, history of device extraction, history of erythema at the implant site, or negative culture results. When cases are identified, positive outcomes may be obtained when allergen-guided reimplantation is performed. Contact allergy to cardiac devices is an uncommon but important phenomenon.

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