Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas

Abstract

Myelolipoma is a rare tumor composed of fat and bone marrow components, most of which are located in the adrenal gland. Myelolipoma in the liver is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In one of these cases, the hepatic myelolipoma was found within a hepatocellular carcinoma (HCC). In the present study, we report the first case of the synchronous occurrence of hepatic myelolipoma and HCCs in different liver sections of one patient, a 26-year-old female who was admitted to our hospital because of a 4-d history of upper abdominal pain. The unenhanced computed tomography (CT) images showed a well-defined low-density mass with adipose components in the right liver lobe, 4.2 cm × 4.1 cm in size. Two inhomogeneous low-density masses were found in the left liver lobe, 8.6 cm × 7.7 cm and 2.6 cm × 2.6 cm in size. The masses in both the right and left liver lobes were heterogeneously enhanced in the contrast-enhanced CT images. Based on the results of the imaging examination, the mass in the right liver lobe was preliminarily considered to be a hamartoma, and the two masses in the left liver were preliminarily considered to be HCCs. We performed a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. Microscopic and immunohistochemical results revealed that the tumor in the right liver lobe was a hepatic myelolipoma, and that the two tumors in the left liver lobe were HCCs.

Cholangiocarcinoma and hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia with pulmonary metastasis and carcinomatosis in a cat

“…Some authors have speculated a possible development of myelolipomas associated with adjacent foci of tumour necrosis from a different neoplasm, as they have occurred synchronously with hepatocellular carcinomas. 10 Therefore, in addition to the possible chronic hypoxia due to the PPDH, the myelolipoma of the current case could also have occurred in association with the adjacent cholangiocarcinoma. Other adipose tissue neoplasms in veterinary medicine include lipomas, angiolipomas, infiltrative lipomas and liposarcomas.…”

“…However, myelolipomas are considered a benign hepatobiliary tumour in cats, composed of adipose tissue and haematopoietic cells. 10 These benign tumours have previously been associated with PPDH, 2,3 and are thought to occur secondary to chronic hypoxia. Some authors have speculated a possible development of myelolipomas associated with adjacent foci of tumour necrosis from a different neoplasm, as they have occurred synchronously with hepatocellular carcinomas.…”

Diagnostic imaging features of hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

“…Thus, the prolonged enclosure of the hepatic parenchyma in a PPDH without surgical treatment can increase the risk of transformation and malignant changes because of vascular and lymphatic congestion and chronic hypoxia of hepatic tissue [ 14 15 ]. The development of myelolipomas may be associated with the presence of foci of tumor necrosis in human medicine [ 16 ]. Therefore, as these changes are irreversible and surgical treatment of PPDH shows a good prognosis, surgical treatment should be considered in patients with hepatic myelolipoma incarcerated in a PPDH [ 1 ].…”

Primary hepatic myelolipoma: A case report and review of the literature

“…Intralesional hemorrhage, infarctions, and suspicion of malignancy are also indications for surgery[ 38 ]. It is worth mentioning a case reporting the synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas in one patient[ 25 ]. Therefore, we have to emphasize that for those patients in whom malignancy cannot be ruled out, a preoperative biopsy is recommended[ 13 ].…”