Laparoscopic adrenalectomy for a giant adrenal myelolipoma: A case report

Abstract

Case presentation We describe a case of a patient who presented with a mildly symptomatic, giant myelolipoma which was excised by laparoscopic approach without complications. Introduction and importance Adrenal myelolipoma (AML) is a rare tumour composed by fat and myeloid tissues. Usually it is asymptomatic, so the diagnosis is mostly incidental. It is generally located in the right adrenal gland, but it can also be found bilaterally. If its size exceeds 10 cm it is defined as a “giant myelolipoma”; in this case its treatment of choice would be adrenalectomy with an open surgical approach. Clinical discussion Patient's signs and symptoms were mild pain in the right hypochondrium and a positive right Giordano's sign. The mass was detected by a contrast-enhanced CT scan. Once excised it measured 16 cm. Conclusion Laparoscopic adrenalectomy for giant myelolipoma is a safe approach if performed by an expert surgeon, with low risk of bleeding and a better outcome for the patient.

Case report: Adrenal myelolipoma resected by laparoscopic surgery

“…The laparoscopic operation was once considered contraindicated for adrenal tumors exceeding 5-6 cm (26). However, the laparoscopic approach is being increasingly used and extended for larger-size adrenal tumors, and we found 18 articles published reported 23 cases in recent 10 years (3,4,17,25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Table 1 provides further details of these reports.…”

“…Conservative management by surveillance with regular imaging follow-up is the therapy of choice for small, and asymptomatic lesions ( 4 , 25 ). Adrenalectomy is indicated when symptomatology ensues, size greater than 4-7 cm, at a high risk of rupture and bleeding, and suspicion of malignancy in an imaging study ( 4 , 9 , 10 ). As for AMLs >10cm, open surgery is recommended, while just several reports of tumors being removed using minimally invasive strategies.…”

“…Table 1 provides further details of these reports. Our literature review observes that AML with diameters up to 16 cm can be safely removed through transperitoneal laparoscopy ( 3 , 4 ). Only one patient converted to open exploratory laparotomy due to multiple adhesions of the previous abdominal surgery which was conducted 6 years ago for a motor vehicle accident ( 27 ).…”

“…Generally, conservative treatment strategies are preferred. However, if symptoms develop, mass growth accelerates rapidly, or if it exceeds 6 cm, adrenalectomy will be the best option ( 4 ). While open surgical removal of giant AMLs is considered to be the treatment of choice, there have been increasing reports of giant AMLs successfully managed with minimally invasive techniques.…”

Giant splenic myelolipoma in a cat with hyperthyroidism

“… 4 – 7 Giant myelolipomas are masses measuring >10 cm. 8 In humans, myelolipomas are reported to occur predominantly within the adrenal gland, with occasional reports of extra-adrenal myelolipoma. 3 To date, the human medical literature contains only four cases of myelolipoma occurring in the spleen.…”