Case Report: An incidentaloma that catches your eye - adrenal myelolipoma

Abstract

Adrenal incidentaloma refers to the incidental finding of a tumor Background in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma.The patient was a 54 year old obese female with a recent Case description: diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma. An MRI was performed revealing a 7x6cm lesion in the right adrenal area indicating a giant adrenal adenoma. An adrenalectomy was performed without complications. The pathology report identified a myelolipoma.The incidence of myelolipoma has recently increased due to Discussion: advances in radiological techniques. Its etiology is unclear and the most accepted theories support a myeloid cell metaplasia in the embryonic stage as a result of stress, infections, or adrenocorticotropic hormone or erythropoietin stimulus. Contributing components may include bone morphogenetic protein 2 and β-catenin, as well as the presence of the chromosomal translocation (3, 21) (q25; p11). Despite its benign nature, the association with other adrenal lipomas must be ruled out. A biochemical evaluation is essential for detecting subclinical states, such as Cushing syndrome and pheochromocytoma. Adrenal myelolipomas are rare benign tumors that are generally Conclusion: asymptomatic. Uncertainty still exists surrounding their etiology. Surgical management depends on hormone production, tumor size, high risk features on imaging and patient consent. Additional information is needed to better understand myelolipomas, their etiology, and clinical management. Incidentalomas may confuse the physician and patient. Ensuring proper multidisciplinary management based on the clinical guidelines of endocrinology allowed a satisfactory resolution of this case.

Giant adrenal myelolipoma treated by laparoscopic excision: A case report and review of literature

“…Tumour size has been reported in the literature from a few millimetres to more than 30cm, but rarely exceeds 5cm [22]. They frequently present between the fifth and seventh decades of life without a predominance in either sex, though there is a greater incidence in the right adrenal gland [25]. The youngest patient was 1-year-old at the diagnosis, while the oldest was 83 years old [23] .…”

Giant Adrenal Myelolipoma as a Cause of Chronic Abdominal Pain: Abdominal Pain due to Giant Myelolipoma

“…Infrequently they have been located in the intracranial position, liver and lung. In any case, the development of tumors in these locations is exceptional, especially in their hyperfunctional forms, although they must be taken into account when they originate in the upper pole of the kidney [9]. Some researchers have identified chromosomal translocations (3,21) (q25; p11) in patients with myelolipomas and hematologic malignancies.…”