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Journal of Clinical Pathology Sep 2001Fatty tumours of the adrenal gland are uncommon and their features have received little attention in the literature. The aim of this study is to analyse the features of... (Review)
Review
AIMS
Fatty tumours of the adrenal gland are uncommon and their features have received little attention in the literature. The aim of this study is to analyse the features of adrenal lipomatous tumours.
METHODS
The histological features of primary adrenal tumours reported over a 30 year period (1970 to 1999) in Queen Mary Hospital, Hong Kong were reviewed and the clinicopathological features of adrenal lipomatous tumours were analysed.
RESULTS
Adrenal lipomatous tumours were noted in 20 patients (12 men, eight women), and they accounted for 4.8% of the primary adrenal tumours reported. The adrenal fatty tumours comprised 11 myelolipomas, three lipomas, three teratomas, two angiomyolipomas, and one liposarcoma. Calcification or bone was noted in one third (seven of 20) of the adrenal tumours. In some fatty tumours (myelolipoma and angiomyolipoma), the fatty component may be inconspicuous. This is the first report in the English literature of angiomyolipoma and liposarcoma of the adrenal gland.
CONCLUSIONS
Different types of fatty tumours were noted in the adrenal gland. A high index of suspicion should be maintained with an aim of surgical treatment for selected patients with large and symptomatic adrenal lipomatous lesions. Histological confirmation is needed for diagnosis.
Topics: Adolescent; Adrenal Gland Neoplasms; Adult; Aged; Aged, 80 and over; Angiomyolipoma; Female; Humans; Lipoma; Liposarcoma; Male; Middle Aged; Myelolipoma; Neoplasms, Adipose Tissue; Teratoma
PubMed: 11533079
DOI: 10.1136/jcp.54.9.707 -
Indian Journal of Pathology &... 2022Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a...
Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Humans; Lipoma; Myelolipoma; Tomography, X-Ray Computed
PubMed: 35900504
DOI: 10.4103/ijpm.ijpm_182_21 -
Iranian Journal of Kidney Diseases Jan 2020As a rare and normally-benign and functionless tumor, primary adrenal myelolipoma comprises adipose tissue and myeloid cells, and its diagnosis is usually difficult... (Review)
Review
As a rare and normally-benign and functionless tumor, primary adrenal myelolipoma comprises adipose tissue and myeloid cells, and its diagnosis is usually difficult owing to its asymptomatic nature. Imaging techniques can detect these masses in over 90% of the cases. CT scan is the most sensitive imaging technique, which can display the tissue nature of this tumor with a high resolution. The present case report involves a 45-year-old woman with bilateral adrenal myelolipoma diagnosed with imaging methods.
Topics: Adrenal Gland Neoplasms; Female; Humans; Middle Aged; Myelolipoma; Tomography, X-Ray Computed
PubMed: 32156843
DOI: No ID Found -
Cleveland Clinic Journal of Medicine 1993Myelolipomas are benign tumors composed of fat cells and mature bone marrow elements. They usually occur in the adrenal glands; fewer than 20 extra-adrenal myelolipomas... (Review)
Review
Myelolipomas are benign tumors composed of fat cells and mature bone marrow elements. They usually occur in the adrenal glands; fewer than 20 extra-adrenal myelolipomas have been reported. Myelolipomas may be found in abdominal, pelvic, or mediastinal sites. We report a patient with a right posterior mediastinal myelolipoma that was successfully resected.
Topics: Aged; Female; Humans; Lipoma; Mediastinal Neoplasms
PubMed: 8443938
DOI: 10.3949/ccjm.60.1.69 -
Biomedicines Nov 2023Our aim is to update the topic of adrenal tumours (ATs) in congenital adrenal hyperplasia (CAH) based on a multidisciplinary, clinical perspective via an endocrine... (Review)
Review
Our aim is to update the topic of adrenal tumours (ATs) in congenital adrenal hyperplasia (CAH) based on a multidisciplinary, clinical perspective via an endocrine approach. This narrative review is based on a PubMed search of full-length, English articles between January 2014 and July 2023. We included 52 original papers: 9 studies, 8 case series, and 35 single case reports. Firstly, we introduce a case-based analysis of 59 CAH-ATs cases with four types of enzymatic defects (CYP21A2, CYP17A1, CYP17B1, and HSD3B2). Secondarily, we analysed prevalence studies; their sample size varied from 53 to 26,000 individuals. AT prevalence among CAH was of 13.3-20%. CAH prevalence among individuals with previous imaging diagnosis of AT was of 0.3-3.6%. Overall, this 10-year, sample-based analysis represents one of the most complex studies in the area of CAH-ATs so far. These masses should be taken into consideration. They may reach impressive sizes of up to 30-40 cm, with compressive effects. Adrenalectomy was chosen based on an individual multidisciplinary decision. Many tumours are detected in subjects with a poor disease control, or they represent the first step toward CAH identification. We noted a left lateralization with a less clear pathogenic explanation. The most frequent tumour remains myelolipoma. The risk of adrenocortical carcinoma should not be overlooked. Noting the increasing prevalence of adrenal incidentalomas, CAH testing might be indicated to identify non-classical forms of CAH.
PubMed: 38002081
DOI: 10.3390/biomedicines11113081 -
Annals of Medicine and Surgery (2012) Sep 2020Myelolipomas are very rare benign tumours consisting of hematopoietic cells and mature adipose tissues. They are most commonly found in the adrenal glands. However,...
INTRODUCTION
Myelolipomas are very rare benign tumours consisting of hematopoietic cells and mature adipose tissues. They are most commonly found in the adrenal glands. However, there have been several reported cases of extra-adrenal myelolipomas, most commonly in the presacral region. Nearly all presacral lesions are small and asymptomatic; thus, most are discovered incidentally on imaging studies.
PRESENTATION OF CASE
We report two cases of presacral myelolipomas. The first is a 48-year-old female presenting with atypical back pain, found to have a mass in her presacral region with a size of 3,3 cm. The second case is a 59-year-old female, who presented for evaluation of a hip fracture, found to have a 4,7 cm presacral lesion. Both presacral myelolipomas were discovered incidentally and were confirmed by percutaneous guided fine-needle aspiration biopsy. Both were treated conservatively.
DISCUSSION
Accepted indications for the surgical excision of myelolipomas are symptomatic tumour, size >4 cm, metabolically active tumour, and a suspicion of malignancy on an imaging study. However, previous reports have documented that nearly half of the conservatively managed myelolipomas with a mean initial size of 5,1 cm, has increased in size or became symptomatic over a 3-years period.
CONCLUSION
We conclude that symptomatic presacral myelolipomas or lesions larger than 4 cm should be en-bloc resected, and we present an intuitive decision-making algorithm.
PubMed: 32904073
DOI: 10.1016/j.amsu.2020.07.002 -
Gland Surgery Dec 2020The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses,... (Review)
Review
The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.
PubMed: 33447584
DOI: 10.21037/gs-20-559 -
BMC Surgery Jun 2017Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to... (Review)
Review
BACKGROUND
Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation.
CASE PRESENTATION
Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of tumor was done.
CONCLUSION
Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.
Topics: Abdominal Pain; Adrenal Gland Neoplasms; Adult; Hemoperitoneum; Humans; Laparotomy; Male; Myelolipoma; Shock, Hemorrhagic
PubMed: 28651560
DOI: 10.1186/s12893-017-0270-6 -
Frontiers in Cardiovascular Medicine 2021Adrenal myelolipoma (AML) is a nonfunctional benign neoplasm from the adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no...
Adrenal myelolipoma (AML) is a nonfunctional benign neoplasm from the adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no symptoms. However, some patients with hypertension and blood pressure normalize after AML surgery, indicating some connections between AML and hypertension. This was a retrospective cohort study of 369 patients diagnosed with AML from September 2008 to December 2018 collected in the Urology Department of West China Hospital, Chengdu, Sichuan, China. We collected clinical records of patients before surgery. Postoperative follow-up was also carried out for those with hypertension and whether patients needed to take antihypertensive drugs and postoperative blood pressure were recorded. We aim to explore the characteristics of both patients with AML having hypertension and having remission of hypertension in 1 year after surgery. There were 369 patients with AML included in the study, 156 men and 213 women, aged 49.86 ± 11.61 years old. Among them, 121 (32.8%) patients presented with hypertension. Body mass index was significantly higher in the hypertension group than that in the nonhypertension group, even after adjusting other variables (26.26 ± 3.43 vs. 24.28 ± 3.38 kg/m, < 0.001 for both univariate and multivariate analyses). Sixty patients were followed up for 1-9 years, with a median follow-up of 52 months. The duration of hypertension in the remission group was shorter than that in the non-remission group ( = 0.020), and the tumor lateralization was significantly different between the two groups ( = 0.005). Nearly one-third of patients with AML suffered from hypertension in our study, and there existed some potential links between AML and hypertension. To be more specific, AML-related hypertension was more likely to result from obesity and renal compression by perirenal fat than from endocrine disorders or blood vessels compression. Patients with AML and with more than 3 years of hypertension might have less possibility to recover.
PubMed: 34568440
DOI: 10.3389/fcvm.2021.663346 -
American Family Physician Jun 2010The increasing use of cross-sectional imaging has led to an increase in the incidental discovery of adrenal masses (adrenal incidentalomas). Although most of these... (Review)
Review
The increasing use of cross-sectional imaging has led to an increase in the incidental discovery of adrenal masses (adrenal incidentalomas). Although most of these lesions are benign, they often present a diagnostic dilemma. Before creating a management plan, the physician should determine if the lesion is benign or malignant and if the lesion is functioning or nonfunctioning. Incidentally discovered adrenal masses usually are benign adenomas; however, myelolipomas, cysts, hemorrhage, pheochromocytomas, metastases, and adrenocortical carcinomas are also possible. Unenhanced computed tomography and chemical shift magnetic resonance imaging can characterize most adenomas because the lesions have high lipid content. Contrast-enhanced computed tomography can further characterize the adenomas because of the washout characteristics with iodinated intravenous contrast media. Fluorodeoxyglucose- positron emission tomography can be helpful in characterizing some lesions, and biopsy is rarely required. This article summarizes the American College of Radiology Appropriateness Criteria for the use of imaging modalities and biopsy to characterize incidentally discovered adrenal masses.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenal Glands; Biopsy; Diagnosis, Differential; Humans; Incidental Findings; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 20521756
DOI: No ID Found