Pathologic analysis, diagnosis and treatment of adrenal myelolipoma

Abstract

With the widespread use of non-invasive imaging modalities, the incidental detection of myelolipoma has become more common. We analyze the clinical data of 4 typical cases of unilateral adrenal myelolipomas, including 1 hormonally inactive patient and 3 hormonally active cases with hyperaldosteronemia, hypercortisolism and hyperandrogenemia. Obvious differences were found in the pathological sections. To our knowledge, this is the first article discussing the etiology of adrenal myelolipoma from pathologic analyses.

Adrenal Myelolipoma Diagnosed in a 72-Year-Old Patient with Abdominal Pain

“…In addition, histopathological analysis is useful for studying and establishing differences between hormonally active and nonactive myelolipomas. Su et al [1] analyzed two distinct cases of myelolipoma in which histopathology revealed the presence of mature adipose tissue and hematopoietic elements in hormonally active adrenal tissues, indicating that extrinsic compression may contribute to anatomical and functional abnormalities of the adrenal cortex. According to the authors, the excessive hormonal stimulation by the abnormal adrenal cortex is involved with the transformation of adrenal tissue into myeloid cells and liposubstitution.…”

“…Constituting a benign tumor of origin in the adrenal gland cortex, adrenal myelolipoma is composed of a variable mixture of mature adipose tissue and elements of hematopoietic tissue [1], and is more commonly presented as an incidental finding. Although rare, its incidence has increased in recent years, mainly because of the increase in diagnostic imaging techniques, such as computed tomography (CT), ultrasonography (USG) and magnetic resonance imaging (MRI) [2].…”

Myelolipoma: a rare incidentally detected adrenal lesion

“…There may be associated hyperplasia of adrenal gland which may result in endocrinological disorder. [6] Endocrinological work up may be helpful in excluding functional myelolipomas. Gershuni et al recommend evalulation of fractionated plasma metanephrines to exclude pheochromocytoma before proceeding for surgery.…”

“…[3] Sometimes adrenal myelolipoma may be symptomatic, presenting with pain, palpable abdominal mass, hypertension, endocrine disorders. [3,5,6] Large tumours may rupture, leading to intraabdominal haemorrhage and may present with shock. [6] Adrenal myelolipoma may be associated sometimes with endocrinological disturbances such as hyperaldosteronism, hypercortisolism, or hyperandrogenemia.…”

“…[3,5,6] Large tumours may rupture, leading to intraabdominal haemorrhage and may present with shock. [6] Adrenal myelolipoma may be associated sometimes with endocrinological disturbances such as hyperaldosteronism, hypercortisolism, or hyperandrogenemia. There may be associated clinically apparent hormonal imbalance due to adrenocortical dysfunction in some cases, and aldosterone hypersecretion may be induced by some factor released by adrenal myelolipoma or due to pressure effects on the adjacent gland by tumor.…”