Perirenal myelolipoma diagnosed on imprint: Case report and review of the literature

Abstract

Myelolipomas are benign tumors containing adipose tissue and hematopoeitic elements which occur most commonly in the adrenal glands. Extra-adrenal myelolipomas are uncommon with few cases of renal and perirenal myelolipomas in the literature. These cases may be difficult to diagnose based on radiology alone and intraoperative diagnosis can be extremely important in determining the course of surgery. Due to the lipomatous component of the tumor it may be technically difficult to prepare adequate frozen sections; this problem can be obviated by utilization of cytologic imprint preparations. We present a case of perirenal myelolipoma diagnosed intraoperatively utilizing cytologic imprint preparations stained with toluidine blue and hematoxylin and eosin.

Giant Myelolipoma in the Spleen

“…21 Myelolipomas have a female predominance and tend to occur in middle age or elderly patients. 22 Myelolipomas are often asymptomatic and are discovered incidentally in the course of radiologic evaluation of the abdomen. Patients rarely present with symptoms such as abdominal pain, except as observed in our case when the tumor was particularly large in size; the other 2 reported cases of myelolipoma in the spleen presented as asymptomatic.…”

“…Patients rarely present with symptoms such as abdominal pain, except as observed in our case when the tumor was particularly large in size; the other 2 reported cases of myelolipoma in the spleen presented as asymptomatic. 20-23 Most extra-adrenal myelolipomas occur independently, but some cases are accompanied by other diseases, such as small lymphocytic lymphoma/chronic lymphocytic leukemia, 24 low-grade B-cell lymphoma, 25 and ovarian steroid cell tumor. 26…”

“…Extra-adrenal myelolipomas vary in size from 2 to 28 cm. 22 Most of them present as a single mass, but rarely, they can present as multiple lesions. 22 Macroscopically, they are spherical to ovoid, circumscribed lesions, and the cut surface typically has a variegated appearance wherein areas of yellow lipid tissue alternate with areas of dark red brown, friable tissue.…”

“…22 Most of them present as a single mass, but rarely, they can present as multiple lesions. 22 Macroscopically, they are spherical to ovoid, circumscribed lesions, and the cut surface typically has a variegated appearance wherein areas of yellow lipid tissue alternate with areas of dark red brown, friable tissue. Microscopically, a myelolipoma consists of a variable admixture of mature adipose tissue with islands and nests of a varying percentage of hematopoietic elements.…”

Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas

“…Extraadrenal myelolipomas are very rare[17]. They have been reported in the parietal pleura[18], presacral area[19], intrathoracic paravertebral area[20], mediastinum[21,22], gastric antrum[23], perirenal tissue[24], and right iliac fossa[25]. To date, only ten cases of hepatic myelolipomas have been reported in the English-language medical literature[3-12] (Table 1).…”