A giant adrenal lipoma presenting in a woman with chronic mild postprandial abdominal pain: a case report

Abstract

IntroductionAdrenal lipomas are rare, small, benign, non-functioning tumors, which must be histopathologically differentiated from other tumors such as myelolipomas or liposarcomas. They are usually identified incidentally during autopsy, imaging, or laparotomy. Occasionally, they may present acutely due to complications such as abdominal pain from retroperitoneal bleeding, or systemic symptoms of infection. We report a giant adrenal lipoma (to the best of our knowledge, the second largest in the literature) clinically presenting with chronic mild postprandial pain.Case presentationA 54-year-old Caucasian woman presented several times over a period of 10 years to various emergency departments complaining of long-term mild postprandial abdominal pain. Although clinical examinations were unrevealing, an abdominal computed tomography scan performed at her most recent presentation led to the identification of a large lipoma of the left adrenal gland, which occupied most of the retroperitoneal space. Myelolipoma was ruled out due to the absence of megakaryocytes, immature leukocytes, or erythrocytes. Liposarcoma was ruled out due to the absence of lipoblasts. The size of the lipoma (16 × 14 × 7 cm) is, to the best of our knowledge, the second largest reported to date. After surgical resection, our patient was relieved of her symptoms and remains healthy six years postoperatively.ConclusionPhysicians should be aware that differential diagnosis of mild chronic abdominal pain in patients presenting in emergency rooms may include large adrenal lipomas. When initial diagnostic investigation is not revealing, out-patient specialist evaluation should be planned to enable appropriate further investigations.

Lipomatous tumours in adrenal gland: WHO updates and clinical implications

“…Chronic inflammatory cells (Kapetanakis et al 2011) were found in a case having symptoms for 10 years. Also, a case had active inflammation and abscess as a result of adjacent infection as a result of percutaneous nephrolithotomy (Gupta et al 2009).…”

“…There are 24 well-documented cases of adrenal lipomas in the English literature (Table 2) (Lange 1966, Prinz et al 1982, Avinoach et al 1989, Lam et al 1997, Ghavamian et al 1998, Sharma et al 1998, Büttner 1999, Lam & Lo 2001, Milathianakis et al 2002, Rodríguez-Calvo et al 2007, Shumaker et al 2008, Gupta et al 2009, Shah & Bhatti 2009, Singaporewalla et al 2009, Goldenberg et al 2011, Gunay et al 2011, Kapetanakis et al 2011, Patel et al 2011, Jain et al 2012, Zhao et al 2014. The first case in the English literature was reported by Lange in 1966(Lange 1966).…”

“…Most of the tumours are yellow with homogenous and soft cut sections. However, patches of haemorrhages could be seen (Lam et al 1997, Singaporewalla et al 2009, Kapetanakis et al 2011, Jain et al 2012. In one case, the bleeding from the vessels in the lipoma resulted in retroperitoneal bleeding (Singaporewalla et al 2009).…”

Giant symptomatic adrenal lipoma, a case report

“…However, with widespread use of imaging techniques more such asymptomatic masses have been discovered, recently (3,13). Uncommonly, patients show symptoms such as abdominal pain, biliary colic, lumbar pain or nephropathy and hypertension (12)(13)(14). Our patient suffered from abdominal pain, too.…”

“…Adrenal lipoma is a very rare nonfunctional tumor with unknown pathogenesis (12). However, with widespread use of imaging techniques more such asymptomatic masses have been discovered, recently (3,13).…”