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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 597-598
 

Adrenal myelolipoma: A rare lesion of adrenal gland


1 Department of Pathology, Tata Main Hospital, Jamshedpur, Jharkhand, India
2 Department of Surgery, Tata Main Hospital, Jamshedpur, Jharkhand, India

Date of Web Publication10-Mar-2016

Correspondence Address:
M R Baisakh
Department of Pathology, Tata Main Hospital, Jamshedpur, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178402

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How to cite this article:
Baisakh M R, Chattoraj A, Narayanan R, Mohanty R, Mishra M. Adrenal myelolipoma: A rare lesion of adrenal gland. Indian J Cancer 2015;52:597-8

How to cite this URL:
Baisakh M R, Chattoraj A, Narayanan R, Mohanty R, Mishra M. Adrenal myelolipoma: A rare lesion of adrenal gland. Indian J Cancer [serial online] 2015 [cited 2019 Dec 15];52:597-8. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/597/178402


Sir,

Myelolipoma is a rare, benign and biochemically inactive tumor of adrenal gland, composed of mature adipose tissue and variable proportion of hematopoietic element. Most of the lesion are asymptomatic and found incidentally during autopsy (0.08-0.4%) or during radiological evaluation for some other disease.[1],[2]

A 53-years-old male, known hypertensive on regular medication, presented with vague intermittent dull aching, dragging pain since last four months. Physical examination was unremarkable. Ultrasound revealed a space occupying lesion of right adrenal gland. A contrast enhanced CT scan revealed an adrenal mass measuring 8 × 6 cm, predominantly showing fat densities and a provisional diagnosis of angiomyolipoma was considered [Figure 1]. Endocrine evaluations for all relevant biochemical parameters like plasma cortisol and plasma catecholamine were within normal limits revealing the nonfunctioning nature of the lesion. An open surgical excision of the right adrenal was performed through extraperitoneal approach and post-operative course was uneventful.
Figure 1: Contrast enhanced CT shows large hypodense retroperitoneal lesion involving upper pole of right kidney

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Gross examination of adrenalectomy specimen showed a globular soft tissue mass measuring 10 × 8 × 5 cm. Cut section showed yellowish fleshy bulging surface with large areas of hemorrhage [Figure 2]. Outer capsule is thinned out. Microscopically revealed a neoplasm composed of mature adipose tissue with intervening hematopoeitic tissue containing erythroid, myeloid and megakaryocytic element [Figure 3] and [Figure 4]. A diagnosis of myelolipoma was made.
Figure 2: Cut surface of the tumor appearing dark brown fleshy with yellowish greasy areas

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Figure 3: Photomicrograph showing mature adipose tissue admixed with hematopoietic element (H and E, ×100)

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Figure 4: Photomicrograph showing both myeloid, erythroid elements along with a megakaryocyte (Arrow) (H and E, ×400)

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Myelolipoma is a rare benign tumor of adrenal gland. The lesion was first described by Gierke in 1905 and coined as 'myelolipoma' by Oberling in 1929.[3] More often reported in 5th-7th decade of life without any sex predilection. Size of the tumor varies from few centimeters to occasional giant myelolipomas.[1],[3],[4] Largest reported case was 6 kg in weight.[4] The pathogenesis is still unknown. However, the most favored theory is metaplasia of reticuloendothelial cells of blood vessels in response to stimuli such as stress, infection and necrosis.[5] Differential diagnosis includes retroperitoneal lipoma, liposarcoma, exophytic renal angiomyolipoma, adrenal adenoma and primary or metastatic malignant adrenal tumor. Many cases of extra-adrenal myelolipomas are reported at different sites such as presacral region and renal sinus. Patient with small and asymptomatic lesion must be kept under routine follow up. However, large and symptomatic lesions should be surgically excised through laparoscopic or open extraperitoneal approach because of risk of spontaneous rupture and intra-tumoral haemorrhage.[2]

 
  References Top

1.
Repassy DL, Csata S, Sterlik G, Ivanyi A. Giant adrenal myelolipoma. Pathol Oncol Res 2001;7:72-3.  Back to cited text no. 1
    
2.
Al Harthi B, Riaz MM, Al Khalaf AH, Al Zoum M, Al Shakweer W. Adrenal myelolipoma a rare benign tumour managed laparoscopically: Report of two cases. J Minim Access Surg 2009;5:118-20.  Back to cited text no. 2
    
3.
Wilhelmus JL, Schordt GR, Alberhasky MT, Alcorn MO. Giant adrenal myelolipoma: Case report and review of literature. Arch Pathol Lab Med 1981;105:532-5.  Back to cited text no. 3
    
4.
Chakraborty J, Paul PC, Gumta MK, Ghosh G, Goswami B. Adrenal myelolipoma-Report of a case. J Indian Med Assoc 2006;104:148-9.  Back to cited text no. 4
    
5.
Chakraborty J, Paul PC, Gumta MK, Ghosh G, Goswami B. Adrenal myelolipoma-Report of a case. J Indian Med Assoc 2006;104:148-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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