Myelolipoma of the Adrenal Gland Associated With Contralateral Renal Cell Carcinoma: Case Report and Review of the Literature

Abstract

Adrenal myelolipoma is a rare benign hormonally inactive tumor. It is frequently detected incidentally on new imaging procedures, such as sonography and computerized tomography and, thus, the question of treatment arises. The association of myelolipomas with obesity, hypertension and malignant tumors has been described previously. We report the second case of myelolipoma associated with renal cell carcinoma. Pathogenesis, differential diagnosis and therapy are discussed.

Adrenal Lipoma

“…5 cm and weighed 225 g. This is probably the largest adrenal lipoma reported. CT scan revealed an extrarenal encapsulated mass with a tissue density equivalent to fat and radiologically differential diagnosis included myelolipoma, retroperitoneal liposarcoma and angiomyolipoma of the kidney [5][6][7].…”

A rare combination consisting of aldosterone-producing adenoma and adrenal myelolipoma in a patient with heterozygosity for retinoblastoma (RB) gene

“…25 Extra-adrenal endocrine dysfunction has been reported with myelolipomas, with rare cases of pituitary Cushing's disease, 20 adrenogenital syndrome associated with an interstitial tumour of the testis 26 and a case of hyperparathyroidism due to a parathyroid adenoma. 27 Moreover, myelolipomas are associated with extra-adrenal pathology, including different types of cancer such as oesophageal, 22 renal, 28 endometrial, 29 breast, 30 gastric 31 and small-cell lung cancer. 32 The exact pathogenesis of adrenal myelolipoma is unknown, but it appears plausible that multiple factors, including hormonal stimulation, are involved.…”

Symptomatic Adrenal Myelolipoma

“…Adrenal myelolipomas are rare benign tumors usually detected incidentally or at autopsy [4,5], Dieckman et al [6] in 1987 and Hofmockelet al [7] in 1995 reviewed the literature till 1991 and found only 70 surgically treated, well-documented cases of adrenal myelolipoma (includ ing 1 extra-adrenal case). The age ranged from 14 to 73 years and the majority were 50-60 years old.…”

“…In contrast, 5 of our patients were symptomatic, and only in 1 case was the mass detected incidentally. The association of adrenal myelolipomas with obesity, hypertension, chronic diseases and malignancies like re nal cell carcinoma of the contralateral [7] or the same side [38], interstitial Leydig cell tumor [39], vaginal [40] or uri nary bladder carcinoma [6], adrenal adenoma [19], en dometrioid carcinoma [22], gastric adenocarcinoma [23], breast carcinoma [24] and pheochromocytoma [33] has been described in the literature. Our case 1 was obese, hypertensive and diabetic, whereas cases 5 and 6 were hypertensive only.…”

“…Of the 70 surgically documented cases reviewed by Dieckman et al [6] in 1987 and Hofmockel et al [7] in 1995, in the literature only half were resected from symp tomatic patients. We reviewed the English literature of the last 5 years and found 41 well-documented surgically removed adrenal myelolipomas which had not been included in the previous review by Hofmockel et al [7], The aim of the present communication is to provide an additional 7 cases of surgically removed myelolipomas in the existing repertoire of this rare entity and discuss the presenting clinical features, CT findings and surgical ther apeutic outcome as observed in our cases vis-à-vis the cases already recorded in the literature. The hypotheses on the possible pathogenetic mechanism are discussed.…”