Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

Abstract

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis.

Video-assisted thoracic surgery for primary myelolipoma of the posterior mediastinum

“…Myelolipomas located in the mediastinum are usually asymptomatic, and there have been no reports of myelolipomas transforming into malignant tumors. The decision-making process for surgical resection is based on a number of factors, including increased tumor size or local symptoms, such as chest pain, hemothorax, or paralysis, caused by spinal cord compression [ 3 , 8 ]. We considered neurogenic tumor, malignant lymphoma, liposarcoma, and pleural mesothelioma in the differential diagnosis but conclusive evidence for these diagnoses was lacking.…”

“…The differential diagnosis of thoracic extra-adrenal myelolipoma and thoracic extramedullary hematopoiesis cannot be confirmed purely on a pathological basis as both these conditions feature hematopoietic elements and adipose tissue [ 11 ]. Although thoracic extramedullary hematopoiesis occurs at multiple sites as lobulated tumors in the thoracic paravertebral area, thoracic extra-adrenal myelolipoma predominantly occurs at a single site as an encapsulated tumor [ 8 ].…”

Thoracic Myelolipoma: A Rare Case of Mistake in Lung Cancer Staging

“…These tumors are typically unilateral, asymptomatic and incidentally diagnosed by imaging detection. Rare cases of bilateral multiple mediastinal myelolipomas have been described and may occur [3]. When they are large-sized (>4 cm), they could be responsible for symptoms such as chest pain, compression of adjacent organs or hemorrhage.…”

Primary mediastinal myelolipoma: a case report and literature review

“…Myelolipoma was first described in 1905 (1), and named "myelolipoma" in 1929 (2). It is composed of mature adipose and hemopoietic tissue, which is a benign tumor, and it is mainly found in the adrenal gland, while the mediastinal location is extremely unusual (3). Until now only 48 cases of mediastinal myelolipoma including our case have been reported (4)(5)(6)(7)(8)(9)(10).…”