Adrenocortical adenoma with myelolipomatous metaplasia: a potential diagnostic pitfall: a case report and review of the literature

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.

A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically

“…Myelolipoma is one of the other variants, which is seen in only 3% of cases [8]. The combination of the two types is considered a rarity with about 20 cases described in the literature so far [8]. Such benign tumors are described as adrenocortical adenomas containing foci of adipose tissue intermixed with bone marrow elements, as was reported in our case.…”

“…The vast majority of incidentalomas are adrenocortical adenomas [2]. Myelolipoma is one of the other variants, which is seen in only 3% of cases [8]. The combination of the two types is considered a rarity with about 20 cases described in the literature so far [8].…”

“…Such benign tumors are described as adrenocortical adenomas containing foci of adipose tissue intermixed with bone marrow elements, as was reported in our case. Firat et al described this appearance as "myelolipomatous changes within adrenocortical adenoma" [9] and Anbardar et al described it as "myelolipomatous metaplasia" [8].…”

Reporte de caso clínico: Tratamiento de Incidentaloma Suprarrenal Gigante con Cirugía Robótica Asistida en Paciente con Laparotomía Previa

“…Sin embargo, debido a que hay algunas ventajas del abordaje mínimamente invasivo en comparación con el abordaje tradicional: menos dolor, hospitalización más corta y recuperación más rápida [1,7,14]. se ha reportado en la literatura casos en donde los mielolipomas gigantes se han abordado por via laparoscópica e incluso utilizando cirugía robotica y con resultados exitosos.…”

Landscape of Adrenal Tumours in Patients with Congenital Adrenal Hyperplasia

“…Differential diagnosis is crucial in these cases [66]. Of note, non-adrenal sites of myelolipoma have been reported as well (for example, mediastinal or renal) in non-CAH patients [107,108]; also, adrenocortical adenoma with myelolipomatous metaplasia should be taken into consideration as an alternative differential diagnosis [109].…”