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Case Reports in Surgery 2020A 42-year-old male patient presented with intermittent abdominal pain and gastrointestinal discomfort present for 4 years. Work-up included ultrasound and computed...
A 42-year-old male patient presented with intermittent abdominal pain and gastrointestinal discomfort present for 4 years. Work-up included ultrasound and computed tomography, which identified a fat-containing splenic mass 5.6 cm in size. Due to recurrent symptoms, the patient sought medical care again. Subsequent images showed an increase in size to 7.6 cm, which was concerning for neoplasm. This was removed via open splenectomy, which was challenging due to intra-abdominal adhesions despite never having had any abdominal surgery. The patient's recovery was uncomplicated. Pathologic assessment indicated that the mass was a myelolipoma. Extra-adrenal myelolipomas are rare and typically found within the retroperitoneum but are extremely rare within the spleen. This case report adds the 6 such case to the literature and demonstrates the need for it to remain in the differential diagnosis of patients with fatty splenic masses, as well as that splenectomy is an appropriate treatment.
PubMed: 32802548
DOI: 10.1155/2020/8839178 -
International Journal of Surgery... 2014To investigate clinical, biochemical and radiological features in 35 patients with adrenal incidentaloma found on CT and/or MRI and to define the management of patients...
PURPOSE
To investigate clinical, biochemical and radiological features in 35 patients with adrenal incidentaloma found on CT and/or MRI and to define the management of patients with adrenal masses.
MATHERIAL AND METHODS
From January 2011 and May 2013, 35 patients (19F, 16M) with an adrenal mass incidentally discovered on CT and/or MRI were enrolled in a retrospective study. Thirthy-two patients underwent MDCT and eight 1.5 MRI.
RESULTS
Patients consisted in 16 males and 19 females, aged between 25 and 89 yo. Adrenal lesions were most commonly found in the sixth decade; in relation to the side of the mass, 20 were found on left side, 15 on the right. Of all the mass analyzed, 3 were <1 cm diameter, 29 between 1 and 4 cm, 3 > 4 cm. The most common finding on CT was adenoma-like appearance (19 cases in relation to size, 14 in relation to attenuation values). Hormonal analysis showed 32 cases of nonfunctional masses and 3 cases of hormone activity. Adrenalectomy was performed in ten patients having adenoma (5 cases), malignant lesions (2 cases), pheocromocitoma, cyst and myelolipoma (1 case).
CONCLUSION
Diagnostic approach to adrenal incidentaloma is focused on the definition of malignancy and hormonal activity; the characterization is needs hormonal and radiological (CT and/or MRI) evaluation, even if a fine needle aspiration is needed in selected cases. Benign and/or non-hypersecreting hormone lesion with <4 cm diameter could be sent to follow-up; active adrenal tumors or >4 cm diameter lesions with malignancy suspicious or growth during follow-up could be treated with surgical adrenalectomy.
Topics: Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Adult; Aged; Biopsy, Fine-Needle; Female; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 24862667
DOI: 10.1016/j.ijsu.2014.05.029 -
Endocrine Regulations Jan 2017The term "adrenal incidentaloma" is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications... (Review)
Review
The term "adrenal incidentaloma" is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications exclusive to adrenal conditions (Udelsman 2001; Linos 2003; Bulow et al. 2006; Anagnostis et al. 2009). This definition excludes patients undergoing imaging testing as part of staging and work-up for cancer (Grumbach et al. 2003; Anagnostis et al. 2009). Papierska et al. (2013) have added the prerequisite that the size of a tumor must be "greater than 1cm in diameter", in order to be called incidentaloma. Although in the most cases these masses are non-hypersecreting and benign, they still represent an important clinical concern because of the risk of malignancy or hormone hyperfunction (Barzon et al. 2003). Th e adrenal tumors belong to the commonest incidental findings having been discovered (Kanagarajah et al. 2012).
Topics: 3-Iodobenzylguanidine; Addison Disease; Adrenal Cortex Neoplasms; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenocortical Adenoma; Adrenocortical Carcinoma; Cushing Syndrome; Diffusion Magnetic Resonance Imaging; Fluorodeoxyglucose F18; Hemorrhage; Humans; Hyperaldosteronism; Indium; Indium Radioisotopes; Lymphoma; Magnetic Resonance Imaging; Myelolipoma; Octreotide; Pheochromocytoma; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Tomography, X-Ray Computed; Ultrasonography
PubMed: 28222025
DOI: 10.1515/enr-2017-0005 -
Oncology Letters Mar 2013Myelolipoma is a rare, benign neoplasm composed of mature adipocytes and hematopoietic tissue, mainly occurring in the adrenal glands. The majority of extra-adrenal...
Myelolipoma is a rare, benign neoplasm composed of mature adipocytes and hematopoietic tissue, mainly occurring in the adrenal glands. The majority of extra-adrenal myelolipomas have been identified in the presacral region and primary mediastinal myelolipoma is very rare. Computed tomography (CT) and magnetic resonance imaging (MRI) are effective methods to detect myelolipoma, while fine-needle aspiration (FNA) combined pathology is able to definitively rule out malignancy. There is no standard method of treatment for the disease. Small (<4 cm) asymptomatic tumors should be monitored, while symptomatic tumors or large (>7 cm) myelolipomas should be removed by surgery. This study describes a patient who presented with two mediastinal myelolipomas that were not encapsulated and presented as a string-of-pearls-type. The pathological diagnosis was myelolipoma and the patient did not relapse within the three years following resection.
PubMed: 23426140
DOI: 10.3892/ol.2012.1085 -
Urology Journal 2006Adrenal myelolipomas are benign lesions that contain hematopoietic and fatty elements. They are usually hormonally inactive and asymptomatic until they reach large...
INTRODUCTION
Adrenal myelolipomas are benign lesions that contain hematopoietic and fatty elements. They are usually hormonally inactive and asymptomatic until they reach large sizes. With the routine use of cross-sectional imaging, these lesions are now being discovered with increasing frequency.
MATERIALS AND METHODS
We performed a comprehensive review of the literature using the PubMed database containing the key word adrenal myelolipoma.
RESULTS
We identified 492 articles written from 1956 to 2006 and reviewed 93 in detail including the authors' own experience. In this review, we highlighted the salient diagnostic features of adrenal myelolipomas and offered a guide for management of these benign lesions.
CONCLUSION
Adrenal myelolipomas may grow over time, but they can usually be followed without surgical excision. In some cases, very large myelolipomas can present with pain and can be confused with necrotic adrenal carcinomas, thus necessitating their surgical removal.
PubMed: 17590837
DOI: No ID Found -
Indian Journal of Endocrinology and... 2022Adrenal incidentalomas (AIs) are seen in around 2% of apparently healthy individuals. These require careful evaluation for the hormone excess state and the presence of...
CONTEXT
Adrenal incidentalomas (AIs) are seen in around 2% of apparently healthy individuals. These require careful evaluation for the hormone excess state and the presence of malignancy prior to intervention.
AIMS
To study the clinical, biochemical, and imaging characteristics of the patients with AI and correlate the diagnosis with the histopathology findings in patients undergoing surgery.
SETTINGS AND DESIGN
Retrospective observational study.
METHODS AND MATERIAL
Patients with adrenal incidentaloma presenting between January 2017 and January 2021 were evaluated as per guidelines provided by the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors. Patients were given final diagnosis on the basis of imaging impression, hormonal activity, and biopsy results (when applicable).
RESULTS
Forty-eight patients were evaluated, with 25 being male, the mean age being 40.9 years (8-71), and the mean size of the mass being 6.21 (1.4-13.7) cm. Thirty-five (72.9%) of them underwent surgical excision. The most common diagnosis was myelolipoma (16), followed by pheochromocytoma (10) and adenoma (9). Nineteen patients were found to have hormone-secreting masses. Two patients with pheochromocytoma were normotensive. There was discordance between imaging diagnosis and hormonal status in two patients, with final diagnosis of pheochromocytoma. One patient with extramedullary erythropoiesis of the adrenal gland was subsequently diagnosed with sickle cell anemia and adrenal insufficiency.
CONCLUSIONS
The study highlights the rare possibility of discrepancy between non-contrast CT diagnosis and functional status of AI. There is also a rare possibility of extramedullary erythropoiesis presenting as AI with adrenal insufficiency. Specific evaluation for such rare possibilities should be considered in AI cases as per clinical scenario.
PubMed: 35662767
DOI: 10.4103/ijem.ijem_335_21 -
Endocrinologia Japonica Oct 1990To clarify the indication of surgery in incidentally discovered asymptomatic adrenal masses, we analyzed 386 Japanese cases, 379 cases reported in Japan during the past... (Review)
Review
To clarify the indication of surgery in incidentally discovered asymptomatic adrenal masses, we analyzed 386 Japanese cases, 379 cases reported in Japan during the past 25 years (from 1964 to 1988) and 7 cases from our own experience. From a total of 460 patients, we carefully selected 379 patients satisfying our criterion of the absence of symptoms and signs suggestive of active hormone over-secretion as described in each case report. From the Japanese series, there was a high incidence of pheochromocytoma patients (20 of 37 patients) who had no symptoms and signs but had high plasma or urine catecholamines. Scintigraphy with 131I-meta-iodo-benzyl-guanidine was useful in the diagnosis of pheochromocytoma. For the other asymptomatic adrenal tumors, except for myelolipoma and adrenal cyst, differential diagnosis between malignant and benign adrenal lesions by imaging procedures such as whole body computed tomography (CT), ultrasonography (US), adrenocortical scintigraphy, and angiography was not always possible. In addition, among the 109 patients with cortical tumors whose hormonal data were reported, no clear-cut differentiation of malignant tumor from benign by means of these data could be obtained. Since 1980 whole body CT scanner and high resolution US scanner have become widely available, and there have been 283 cases of asymptomatic adrenal tumors who satisfied our criterion. Cortical carcinomas smaller than 3 cm and 6 cm in diameter account for 3.8% and 6.6%, respectively, of the total of 101 cases of cortical carcinoma, cortical adenoma, ganglioneuroma, and hemangioma during this period. The size of the smallest cortical carcinoma with metastasis was 2 cm in diameter in this series. Pre-operatively, an adrenocortical carcinoma 2.8 cm in diameter in our patient could not be diagnosed as such by imaging techniques and measurement of plasma hormones. These findings suggest that an adrenal mass larger than 3 cm should be removed and a patient with a smaller cortical tumor should be carefully followed up.
Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Aged; Aldosterone; Androstenedione; Corticosterone; Dehydroepiandrosterone; Female; Humans; Hydrocortisone; Male; Middle Aged; Renin; Tomography, X-Ray Computed; Ultrasonography; Vanilmandelic Acid
PubMed: 2150809
DOI: 10.1507/endocrj1954.37.671 -
Modern Pathology : An Official Journal... Apr 2007Extramedullary proliferations of bone marrow elements are infrequently encountered in routine pathology practice. On occasion, they can present diagnostic difficulties... (Review)
Review
Extramedullary proliferations of bone marrow elements are infrequently encountered in routine pathology practice. On occasion, they can present diagnostic difficulties when seen in unusual or unanticipated sites. This review serves to cover aspects of underlying embryogenesis of myeloid elements, as well as sites and circumstance of benign proliferations of myeloid elements along with their occasional confusion with neoplastic myeloid proliferations. Benign proliferations associated with hematologic disorders and hematopoietic growth factors are discussed. Immunohistochemical evaluation of myeloid proliferations is considered as well.
Topics: Biomarkers; Bone Marrow; Bone Marrow Cells; Cell Proliferation; Diagnosis, Differential; Hematopoiesis, Extramedullary; Humans; Liver; Lymph Nodes; Myelolipoma; Sarcoma, Myeloid; Spleen
PubMed: 17334344
DOI: 10.1038/modpathol.3800768 -
Asian Journal of Urology Jan 2022
PubMed: 35198403
DOI: 10.1016/j.ajur.2021.04.006 -
Acta Endocrinologica (Bucharest,... 2022An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal...
BACKGROUND
An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal medulla that originates from primitive neural crest cells, while myelolipoma is a benign tumor of the adrenal cortex comprising of mature adipose tissue and blood components.
CASE REPORT
We present a case of a 52-year-old male who presented with generalized body swelling with episodes of vomiting and diarrhea. There was no history of abdominal pain or any significant history. Routine laboratory investigations and endocrine workup were within normal limits. MRI was performed for unexplained symptoms, and which revealed a solid homogeneous mass measuring 9x7x4.5cm arising from the adrenal gland. A diagnosis of myxoid adrenocortical neoplasm was suggested, and laparoscopic left adrenalectomy was performed based on imaging findings. The final diagnosis of coexisting giant adrenal GN with myelolipoma was made on histopathological examination, which was further confirmed by immunohistochemistry.
CONCLUSION
Ganglioneuroma coexistence with myelolipoma is a rare finding in the adrenal gland. Therefore, histopathology is imperative in such cases for a definitive diagnosis.
PubMed: 36699157
DOI: 10.4183/aeb.2022.379