DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163786

Giant adrenal myelolipoma - clinical spectrum and management: a single centre experience

Santosh Kumar, Ankur Mittal, Aditya Prakash Sharma, Abhinandan Mukhopadhyay

Abstract


Background: Adrenal myelolipomas are rare benign tumor composed of mature adipocytes and normal haematopoetic cells. Giant adrenal myelolipomas are rare clinical entities. Most of them are symptomatic. We present 15 such cases, their clinical spectrum and management.

Methods: Retrospective analysis of giant adrenal myelolipomas from a tertiary level institute. Initial diagnosis was made by computed tomography.

Results: Mean age of patient was 45.6±11 years with slightly higher female preponderance. All patients were overweight with predominantly left sided adrenal myelolipoma. Majority of them (93%) were symptomatic and presented with abdominal pain, anemia or fever. Mean size of the mass on imaging was 14 cm±6 cm, with largest lesion measuring 26 cm.

Conclusions: The article highlights the varying clinical presentations including rare emergency presentations of giant adrenal myelolipomas. A brief literature review is also presented.


Keywords


Adrenal hemorrhage, Adrenal myelolipoma, Giant, Surgical management

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References


Gierke E. Uber Knochenmarksgwebe in der Nebenniere. Zeiglers Beitr Path Anat. 1905;311-24.

Oberling C. Les formations myelolipomateuses. Bull Ass Fr Etude Cancer. 1929;18:234-46.

Hasan M, Siddiqui F, Al-Ajmi M. FNA diagnosis of adrenal myelolipoma: a rare entity. Diagn Cytopathol. 2008;36:925e6.

Lam KY, Lo CY. Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution. J Clin Pathol. 2001;54:707-12.

Sharma MC, Kashyap S, Sharma R, Chumber S, Sood R, Chahal R. Symptomatic adrenal myelolipoma. Clinicopathological analysis of 7 cases and brief review of literature. Urol Int. 1997; 59:119-24.

Kenney PJ, Wagner BJ, Rao P, Heffess CS. Myelolipoma: CT and pathologic features. Radiology. 1998;208:87-95.

Bishoff JT, Waguespack RL, Lynch SC, May DA, Poremba JA, Hall CR. Bilateral symptomatic adrenal myelolipoma. J Urol. 1997;158:1517-8.

Al-Bahri S, Tariq A, Lowentritt B, Nasrallah DV. Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia. Case Rep Surg. 2014;2014:728198.

Almeida MQ, Kaupert LC, Brito LP, Lerario AM, Mariani BMP, Ribeiro M, et al. Increased expression of ACTH (MC2R) and androgen (AR) receptors in giant bilateral myelolipomas from patients with congenital adrenal hyperplasia. BMC Endocr Disord. 2014;14:42.

Saunders RN, Koch CA, Brown KB, Hairston FJ, Daley WP, Ahmed N, et al. Bilateral adrenal myelolipomas in a woman with chronic anticoagulation, postmenopausal uterine bleeding, primary hyperparathyroidism and hyperthyroidism. Am J Med Sci. 2013;346(1):82-5.

McGeoch SC, Olson S, Krukowski ZH, Bevan JS. Giant bilateral myelolipomas in a man with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2012;97(2):343-4.

Cha JS, Shin YS, Kim MK, Kim HJ. Myelolipomas of both adrenal glands. Korean J Urol. 2011;52(8):582-5.

Polamaung W, Wisedopas N, Vasinanukorn P, Pak-art P, Snabboon T. Asymptomatic bilateral giant adrenal myelolipomas: case report and review of literature. Endocr Pract. 2007;13(6):667-71.

Daneshmand S, Quek ML. Adrenal myelolipoma: diagnosis and management. Urol J. 2006;3:71-4.

Akamatsu H, Koseki M, Nakaba H, Sunada S, Ito A, Teramoto S, et al. Giant adrenal myelolipoma: report of a case. Surg Today. 2004;34:283-5.

Kammen BF, Elder DE, Franker DL, Siegelman ES. Extraadrenal myelolipoma: MR imaging findings. Am J Roentgenol. 1998;171:721-3.

Xuefeng T, Rui C, Jianping X, Mingu Y. Myelolipoma of the kidney: a seldom site for a rare extra-adrenal tumor. J Med Coll PLA. 2010;25:317-20.

Talwalkar SS, Shahcen SP 2nd. Extra-adrenal myelolipoma in the renal hilium: a case report and review of the literature. Arch Pathol Lab Med. 2006;13(7):1049-52.

Beraha D, Block HL, Politano VA. Myelolipoma of the kidney. J Urol. 1974;112:19-20.

George SA, Manipadam MT, Thomas R. Primary myelolipoma presenting as a nasal cavity polyp: a case report and review of the literature. J Med Case Reports. 2012;6:127.

Nakajo M, Onohara S, Shinmura K, Fujiyoshi F. Embolization for spontaneous retroperitoneal hemorrhage from adrenal myelolipoma. Radiat Med. 2003;21:214e9.

Chng SM, Lin MB, Ng FC, Chng HC, Khoo TK. Adrenal myelolipoma presenting with spontaneous retroperitoneal haemorrhage demonstrated on computed tomography and angiogram-a case report. Ann Acad Med Singap. 2002;31:228e30.

Hisamatsu H, Sakai H, Tsuda S, Shigematsu K, Kanetake H. Combined adrenal adenoma and myelolipoma in a patient with Cushing's syndrome: case report and review of the literature. Int J Urol. 2004;11:416-8.

Udupa S, Usha M, Visweswara RN, Desai MG. Left-sided giant adrenal myelolipoma secreting catecholamine. Indian J Pathol Microbiol. 2012;55:389-91.

Wadih GE, Nance KV, Silverman JF. Fine-needle aspiration cytology of the adrenal gland. Fifty biopsies in 48 patients. Arch Pathol Lab Med. 1992;116:841-6.

Han M, Burnett AL, Fishman EK, Marshall FF. The natural history and treatment of adrenal myelolipoma. J Urol. 1997;157:1213-6.

Gill IS. The case for laparoscopic adrenalectomy. J Urol. 2001;166:429-36.

Castillo OA, Vitagliano G, Corte O, Sánchez-Salas R, Arellano L. Laparoscopic adrenalectomy for adrenal myelolipoma. Arch Esp Urol. 2007;60:217-21.