Giant Retroperitoneal Myelolipoma: An Unusual Diagnostic GI Challenge—Case Report and Review of the Literature

Vigutto, G; Lauro, Augusto; Vaccari, Samuele; Pirini, Maria Giulia; Diegoli, Marta; D’Andrea, Vito; Marino, Ignazio R.; Cervellera, Maurizio; Tonini, Valeria

doi:10.1007/s10620-019-05897-9

Cited by 5 publications

(5 citation statements)

References 28 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adrenal myelolipomas can rarely present with dyspnea, back pain, fever, weight loss, and virilization [ 14 ]. Therefore, myelolipomas-related symptoms, which can result from mass effect symptoms or even acute abdomen because of tumor compression or hemorrhage, are unspecific for diagnosing these tumors [ 15 ]. So, further diagnostic approaches are required.…”

Section: Discussionmentioning

confidence: 99%

“…Also, in magnetic resonance imaging (MRI), hyperintensity of fat on T1 and T2 weighted sequences favor myelolipoma [ 16 ]. When imaging cannot exclude malignancy, a fine needle biopsy may be helpful [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, conservative management seems sufficient when the diagnosis of myelolipoma is unambiguous and the issues above are absent. As a benign tumor, laparoscopic surgery is safe, and follow-up is optional because the malignant transformation has not been reported [ 1 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Simultaneous adrenal and retroperitoneal myelolipoma resected by laparoscopic surgery: a challenging case

Kamran,

Haghpanah,

Dabbaghmanesh

et al. 2023

BMC Urol

View full text Add to dashboard Cite

Background Myelolipoma is a benign neoplasm of the adrenal cortex, composed of fat and hematopoietic cells. Although myelolipoma is benign, differentiation from adrenocortical cancer may be difficult. The presence of adrenal and extra-adrenal myelolipomas simultaneously is sporadic, making it a challenging case, especially when the preoperative diagnosis is ambiguous. Case presentation A 65-year-old man was referred to our clinic due to a mass in the adrenal fossa. In the abdominopelvic computed tomography (CT), a well-circumscribed fat-containing 78 × 61 × 65 mm bi-lobulated mass was reported in the left adrenal fossa. The first differential diagnosis was myelolipoma. The patient was then referred to our clinic for a mass excision. He was asymptomatic and was scheduled to undergo laparoscopic-assisted adrenalectomy. After adrenalectomy and mass dissection, surprisingly, another mass was detected in the retroperitoneal area. The second mass was also dissected. The final diagnosis was myelolipoma for both masses. The patient has been symptom-free for nine months after the operation. Conclusion Simultaneous adrenal and extra-adrenal myelolipoma should be considered as one of the differential diagnoses. However, because this situation is extremely rare, the probability of malignancy should be highly regarded, and we suggest an obsessive approach when approaching this condition. It is essential to manage these cases on a case-by-case basis and tailor the management concerning intraoperative biopsy, the intraoperative appearance of tumors, and the location of extra-adrenal masses.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Simultaneous adrenal and retroperitoneal myelolipoma resected by laparoscopic surgery: a challenging case

Kamran,

Haghpanah,

Dabbaghmanesh

et al. 2023

BMC Urol

View full text Add to dashboard Cite

show abstract

“…It accounts for 6% to 16% of adrenal incidentalomas and is the second most common cause after adrenal adenomas, with an approximate autopsy prevalence of 0.08% to 0.2% [ 3 , 4 ]. It originates from metaplastic changes in mesenchymal cells or as a result of overstimulation by adrenocorticotropic hormone (ACTH) [ 5 , 6 ]. Clinically, myelolipomas can be asymptomatic or present with abdominal pain or nonspecific symptoms such as fever or weight loss [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

A Case Report and Literature Review of Adrenal Myelolipoma

Duarte Regalado,

Guzmán Mejía,

Gutiérrez Uvalle

et al. 2023

Cureus

View full text Add to dashboard Cite

Adrenal myelolipoma is considered a benign neoplasm that accounts for 6% to 16% of adrenal incidentalomas, and it is the second most common incidental adrenal tumor after adrenal adenomas. They are usually asymptomatic; however, in the presence of symptoms, significant growth, or complications, open surgical resection is indicated. We present the case of a 46-year-old woman with obesity and diabetes who experienced five years of left hemiabdominal pain, which was unsuccessfully treated symptomatically. A computed tomography scan revealed findings suggestive of pancreatic lipoma and a suggestive image of left adrenal myelolipoma. Resection of the tumor was performed using an anterior midline approach, and histopathological examination confirmed left adrenal myelolipoma. The presented case represents the typical presentation of these tumors in a patient in the fifth decade of life with obesity, diabetes, and nonspecific abdominal pain possibly related to the size of the lesion found. Surgical intervention was indicated due to the presence of symptoms, lesion size, contiguity with abdominal organs, and the absence of a precise diagnosis. An anterior midline approach was chosen, and histopathological examination provided a definitive diagnosis. Adrenal myelolipoma is a rare entity that is often asymptomatic and incidentally diagnosed through imaging studies. However, they should be resected when symptomatic to prevent complications. Open surgical resection is the preferred approach.

show abstract

“…Consequently, retroperitoneal PGL mimicking an acute abdomen should make differential diagnosis with retroperitoneal myelolipoma. Extra-adrenal myelolipomas are mostly present in the presacral retroperitoneum[77]. PGLs are mostly located in the retroperitoneum around the organ of Zuckerkandl.Myelolipomas are nonfunctional tumors and do not present any symptoms until reaching large size or having complications [78].…”

mentioning

confidence: 99%

Haemorrhagic retroperitoneal paraganglioma initially manifesting as acute abdomen: a rare case report and literature review

Yang

Wang

et al. 2020

BMC Surg

View full text Add to dashboard Cite

Background Paragangliomas (PGLs) are extremely rare neuroendocrine tumours arising from extra-adrenal chromaffin cells. PGLs are clinically rare, difficult to diagnose and usually require surgical intervention. PGLs mostly present catecholamine-related symptoms. We report a case of Acute abdomen as the initial manifestation of haemorrhagic retroperitoneal PGL. There has been only one similar case reported in literature. Case presentation We present a unique case of a 52-year-old female with acute abdomen induced by haemorrhagic retroperitoneal PGL. The patient had a 5-h history of sudden onset of serve right lower quadrant abdominal pain radiating to the right flank and right lumbar region. Patient had classic symptoms of acute abdomen. Abdominal ultrasound revealed a large abdominal mass with a clear boundary. A Computed Tomography Angiography (CTA) of superior mesenteric artery was also performed to in the emergency department. The CTA demonstrated a large retroperitoneal mass measured 9.0 × 7.3 cm with higher density inside. A provisional diagnosis of retroperitoneal tumour with haemorrhage was made. The patient received intravenous fluids, broad-spectrum antibiotics and somatostatin. On the 3rd day of admission, her abdominal pain was slightly relieved, but haemoglobin decreased from 10.9 to 9.4 g/dL in 12 h suggesting that there might be active bleeding in the abdominal cavity. Thus, we performed a midline laparotomy for the patient. Haemorrhage was successfully stopped during operation. The retroperitoneal tumour with haemorrhage was completely removed. The abdominal pain was significantly relieved after surgery. The patient initially presented with acute abdomen instead of catecholamine-related symptoms. The diagnosis of retroperitoneal PGL with haemorrhage was finally confirmed by postoperative pathological and immunohistochemical results. The postoperative course was uneventful. At the 1-year follow-up visit, no tumour recurrence was observed by Single Photon Emission Computed Tomography. A literature review was performed to further understand and analyse the aforementioned disease. Conclusion Acute abdomen as the initial manifestation of haemorrhagic retroperitoneal paraganglioma is extremely rare. Abdominal Computed Tomography is essential to locate the lesion and differentiate between other causes of acute abdomen. PGLs are hypervascular tumours. We should be aware that ruptured retroperitoneal PGL with massive bleeding could be life threatening and require emergency laparotomy.

show abstract

Giant Retroperitoneal Myelolipoma: An Unusual Diagnostic GI Challenge—Case Report and Review of the Literature

Cited by 5 publications

References 28 publications

Simultaneous adrenal and retroperitoneal myelolipoma resected by laparoscopic surgery: a challenging case

Simultaneous adrenal and retroperitoneal myelolipoma resected by laparoscopic surgery: a challenging case

A Case Report and Literature Review of Adrenal Myelolipoma

Haemorrhagic retroperitoneal paraganglioma initially manifesting as acute abdomen: a rare case report and literature review

Contact Info

Product

Resources

About