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COMMENTARY
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 85  

Adrenal myelolipoma: A rare entity


Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Submission09-Jul-2019
Date of Decision13-Aug-2019
Date of Acceptance15-Oct-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_184_19

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How to cite this article:
Das S. Adrenal myelolipoma: A rare entity. Med J DY Patil Vidyapeeth 2020;13:85

How to cite this URL:
Das S. Adrenal myelolipoma: A rare entity. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Jul 7];13:85. Available from: http://www.mjdrdypv.org/text.asp?2020/13/1/85/272877



Adrenal myelolipomas are nonfunctioning benign tumors composed of adipose tissue and hemopoietic elements resembling bone marrow.[1] The lesion was first described by Glerke in 1905 and coined as “myelolipoma” by Oberling in 1929.[2] Initially, myelolipomas were detected incidentally during autopsy with a detection rate of 0.08%–0.2%. However, with the advent of computed tomography (CT) scan and magnetic resonance imaging, more adrenal myelolipomas are being reported, with <300 cases being detected by the year 2000.[3]

Adrenal myelolipomas are rare, benign, nonfunctioning tumors composed of mature adipose tissue and hemopoietic elements. They comprise 5.8% of adrenal tumors, with a male-to-female ratio of 1.3:1. They are usually unilateral with right-sided predominance but may be occasionally bilateral with extra-adrenal involvement such as retroperitoneum, thorax, and pelvis.[4]

Adrenal myelolipomas are associated with four distinct clinicopathological syndromes which include (a) isolated adrenal myelolipoma, (b) adrenal myelolipoma associated with acute hemorrhage, (c) extra-adrenal myelolipoma, and (d) adrenal myelolipoma associated with other adrenal disorder.

Usually, adrenal myelolipomas are <4 cm in size, but, occasionally, giant myelolipomas have been reported. The largest myelolipoma was reported first by Pagana TJ et al. which measured 31 cm × 24.5 cm × 11.5 cm and weighed 6 kg.[5]

The first excision of a myelolipoma was carried out in 1922. Since then, >100 cases of surgically resected adrenal myelolipomas have been documented. They affect patients in their fourth to sixth decades, may be clinically asymptomatic, or may present with dull-aching, abdominal pain which can be misinterpreted as retroperitoneal liposarcomas on radiological examination.[6]

The exact pathogenesis of adrenal myelolipomas remains unclear. Various theories have been suggested regarding their pathogenesis; however, the most favored theory is metaplasia of reticuloendothelial cells of blood vessels in response to external stimuli.[7]

Initially, patients with myelolipoma underwent surgical recession. Nowadays treatment is decided by the size of the tumor. When the tumor size is 4 cms or less and are asymptomatic, serial followup is recommended. However, if symptoms occur, surgery with adequate care should be done. During the course of surgery, spontaneous rupture with hemorrhage is possible and hence adequate precaution with regard to this should be taken.[8]



 
  References Top

1.
Decmann Á, Perge P, Tóth M, Igaz P. Adrenal myelolipoma: A comprehensive review. Endocrine 2018;59:7-15.  Back to cited text no. 1
    
2.
Liu W, Chen W, He X. An unusual cause of Cushing's syndrome and virilization. Gastroenterology 2015;149:e5-6.  Back to cited text no. 2
    
3.
Lam AK. Lipomatous tumours in adrenal gland: WHO updates and clinical implications. Endocr Relat Cancer 2017;24:R65-79.  Back to cited text no. 3
    
4.
Kammen BF, Elder DE, Fraker DL, Siegelman ES. Extraadrenal myelolipoma: MR imaging findings. AJR Am J Roentgenol 1998;171:721-3.  Back to cited text no. 4
    
5.
Pagana TJ, Karasick SJ, Karasick D, Stahlgren LH. Myelolipoma of the adrenal gland. Am J Surg 1981;141:282-5.  Back to cited text no. 5
    
6.
Bovo G, Picozzi SC, Viganò P, Giuberti A, Casu M, Manganini V, et al. Giant adrenal myelolipoma: Report of a case and review of the literature. Minerva Urol Nefrol 2007;59:455-8.  Back to cited text no. 6
    
7.
Brogna A, Scalisi G, Ferrara R, Bucceri AM. Giant secreting adrenal myelolipoma in a man: A case report. J Med Case Rep 2011;5:298.  Back to cited text no. 7
    
8.
Olsson CA, Krane RJ, Klugo RC, Selikowitz SM. Adrenal myelolipoma. Surgery 1973;73:665-70.  Back to cited text no. 8
    




 

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