Giant adrenal myelolipomas: CT and MRI findings

Abstract

The computed tomographic (CT) and magnetic resonance imaging (MRI) features of three giant myelolipomas of the adrenal gland are presented in two patients. CT demonstrates large, fatty retroperitoneal tumors that may be confused with retroperitoneal liposarcoma or very large renal angiomyolipoma. MRI with coronal and sagittal imaging is more sensitive than CT in defining the most likely origin of these tumors as the adrenal gland.

Giant adrenal myelolipoma with minimal fat content in a patient with homozygous beta‐thalassemia: Appearance on MRI

“…These tumors, however, are usually catecholamine-secreting and therefore symptomatic, and do not demonstrate a drop in signal on opposed-phase images, like the tumor in our case. The hematopoietic element in myelolipomas usually has SI comparable to that of the spleen on T2-weighted images, and, to our knowledge, there are no reports of such tumors with very high SI (1,3,6,10). We hypothesize that the very high SI of the tumor on T2-weighted images in our case may be attributed to a combination of increased interstitial space and intense hemorrhagic infiltration, as was demonstrated on pathology.…”

“…It is usually Ͻ5 cm in size, but it can vary from microscopic tissue up to 34 cm (4,6). It is usually asymptomatic, causing pain when hemorrhage, necrosis, or compression occurs.…”

Bilateral Symptomatic Adrenal Myelolipoma

“…Of 128 surgically documented adrenal myelolipomas reported in the literature, only 50 were symptomatic, and bilateral tumors have also been reported in 4 cases [2][3][4][11][12][13]. The primary tumor size varied from several millimeters to more than 30 cm [4]; usually it is less than a few centimeters in diameter. Our patient was a young woman with a bilateral and unusually large and symptomatic tumor.…”

“…Usually only monolateral adrenalectomy is performed, even in the presence of bilateral tumors, to preserve the adrenal function. To our knowledge only 5 patients have previously been described who have been surgically treated for bilateral myelolipoma [2][3][4].…”

Symptomatic Adrenal Myelolipoma

“…In contrast, 5 of our patients were symptomatic, and only in 1 case was the mass detected incidentally. The association of adrenal myelolipomas with obesity, hypertension, chronic diseases and malignancies like re nal cell carcinoma of the contralateral [7] or the same side [38], interstitial Leydig cell tumor [39], vaginal [40] or uri nary bladder carcinoma [6], adrenal adenoma [19], en dometrioid carcinoma [22], gastric adenocarcinoma [23], breast carcinoma [24] and pheochromocytoma [33] has been described in the literature. Our case 1 was obese, hypertensive and diabetic, whereas cases 5 and 6 were hypertensive only.…”