Giant adrenal myelolipoma, a rare urological issue with increasing incidence: a case report

Abstract

IntroductionAdrenal myelolipomas are relatively rare, non-functioning benign tumours composed of mature fatty and active hematopoietic elements. They can be asymptomatic, even if their size is massive. Diagnosis is relatively simple using ultrasound, computed tomography and magnetic resonance imaging. Surgical resection through an extraperitoneal approach is advocated in cases of symptomatic or large myelolipomas exceeding 5-cm in diameter. Their low incidence seems to be increasing from 0.2% to 10% during the last decade.Case presentationWe present a case of a giant adrenal myelolipoma in a 68-year-old Caucasian male, who was presented with left lumbar pain. Renal ultrasound, CT and MRI demonstrated a well demarcated mass, with a maximum diameter of 10-cm. The differential diagnosis comprised the adrenal myelolipoma, the retroperitoneal liposarcoma and the renal angiomyolipoma. Thus, the patient was subjected to a left adrenalectomy.ConclusionMultiple theories have been proposed for the increasing frequency and natural course of the adrenal myelolipoma, with chronic adrenal stimulation and the contemporary stressful lifestyle to be the most appealing. Surgical treatment is advocated through an extraperitoneal approach because of the quicker recovery of the patient and the smaller postoperative complication rate.

Incidental diagnosis of an adrenal myelolipoma: case report

“…Associations noted with adrenal myelolipomata such as obesity, hypertension and diabetes were present in this patient [6]. They have a relatively slow growth rate with a doubling time of 4.6 to 95.1 months [5].…”

Non Functional Unilateral Adrenal Myelolipoma, A Case Report

“…The most widely accepted amongst all of them is that due to metaplastic change in the reticuloendothelial cells of blood capillaries in response to stimuli including necrosis, infection or stress [8]. Prolonged stimulation with high level of adrenocoticotropic hormone or adrenal androgen also has been sought as cause of this benign lesion.…”

“…Gagner et al, introduced laparoscopic adrenalectomy for the treatment of both functioning and non-functioning adrenal tumours [15]. Usually lesions which are asymptomatic and measure <5cm are monitored over a period of 1 to 2 years with imaging [8].…”

Multicentric Adrenal Myelolipomas: Case Report

“…The treatment of adrenal myelolipomas should be individualized [9]. The patient has a small, less than 5 cm in diameter, and asymptomatic myelolipoma, that could be observed conservatively around 6 -12 months interval follow-up by using ultrasound or CT for a 1 -2 year period [2,9].…”

“…The patient has a small, less than 5 cm in diameter, and asymptomatic myelolipoma, that could be observed conservatively around 6 -12 months interval follow-up by using ultrasound or CT for a 1 -2 year period [2,9]. On the contrary, a symptomatic lesion or a large than 5 cm in diameter myelolipoma should be surgically excised, because there are reports about spontaneous rupture and hemorrhage risks of the mass leading to life-threatening cardiovascular shock [9]. The classical treatment of both functioning and non-functioning adrenal tumors has become laparoscopic adrenalectomy by starting to do minimally invasive surgery [2].…”