Rib myelolipoma: a case report.

BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.

[Primary mediastinal myelolipoma]. / Mielolipoma primario mediastinal.

Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomography and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en estudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia magnética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

[Adrenal myelolipoma, review of the literature in Mexico apropos of two cases]. / Mielolipoma Suprarrenal, revisión de literatura en México a propósito de dos casos.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications.

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Mielolipoma suprarrenal, revisión de literatura en México a propósito de dos casos / Adrenal myelolipoma, review of the literature in Mexico apropos of two cases

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications

A Rare Case of Congenital Adrenal Hyperplasia with Giant Adrenal Myelolipoma.

Adrenal incidentalomas are tumors located in the adrenal glands and found on imaging done for purposes not related to adrenal disease. In other cases adrenal mases can be radiologically found when an adrenal hormone secreting tumor is suspected, such as a pheochromocytoma or Cushing's diseases. Adrenal incidentalomas may be classified as functional or non-functional based on whether they produce hormones, such as aldosterone, cortisol, and androgens, or catecholamines. Studies indicate that around 8% of adrenal incidentalomas are adrenal gland myelolipomas (AGMs). AGMs are non-malignant masses that can cause the compression of vital organs and vessels if said masses become large enough. In patients with congenital adrenal hyperplasia (CAH), adrenocorticotropic hormone (ACTH) levels tend to be elevated due to the lack of adrenal-hormone production. Patients with CAHs are treated with steroids that suppress ACTH levels and prevent adrenal gland hyperplasia. Around 10% of AGMs are found in untreated CAHs. Our patient was a 36-year-old male who was on steroids due to CAH and intermittent abdominal pain; a CT scan revealed a large left adrenal mass that was displacing organs towards the right. Pathological analysis revealed an AGM exceeding 30 x 23.6 x 16.7 cm. This AGM is one of the largest ever to be reported in the literature.

Hepatic myelolipomas in Callimico goeldii (Thomas, 1904) kept in captivity

Myelolipoma is an unusual benign neoplasm in veterinary medicine. This work intended to report the occurrence of hepatic myelolipomas in Neotropical primates of the Callimico goeldii species kept in captivity. These cases were diagnosed during necropsy in a survey on liver neoplasms in the period of 2004 to 2008. Two cases were found in adult male, and two in adult female animals. The diagnoses were obtained through data analysis of necropsy records, pathological examination of the cases, and histological confirmation. Three (75%) of the animals showed clinical signs of progressive weight loss, and two (50%) of them exhibited regional abdominal bloating. The livers had protrusions of pale yellow color on the surface of all lobes. Histologically, the tumors were formed by mature myeloid tissue with high hematopoietic cellularity, represented by the megakaryocytes and meroblastic cells and immature erythroblasts. We conclude that non-human primates of the Callimico goeldii species might have predisposition for liver myelolipoma, which are neoplasms that can lead to the failure and destruction of this organ.(AU)

Hepatic myelolipomas in Callimico goeldii (Thomas, 1904) kept in captivity

Myelolipoma is an unusual benign neoplasm in veterinary medicine. This work intended to report the occurrence of hepatic myelolipomas in Neotropical primates of the Callimico goeldii species kept in captivity. These cases were diagnosed during necropsy in a survey on liver neoplasms in the period of 2004 to 2008. Two cases were found in adult male, and two in adult female animals. The diagnoses were obtained through data analysis of necropsy records, pathological examination of the cases, and histological confirmation. Three (75%) of the animals showed clinical signs of progressive weight loss, and two (50%) of them exhibited regional abdominal bloating. The livers had protrusions of pale yellow color on the surface of all lobes. Histologically, the tumors were formed by mature myeloid tissue with high hematopoietic cellularity, represented by the megakaryocytes and meroblastic cells and immature erythroblasts. We conclude that non-human primates of the Callimico goeldii species might have predisposition for liver myelolipoma, which are neoplasms that can lead to the failure and destruction of this organ.

[Giant adrenal myelolipoma. Right laparoscopic adrenalectomy]. / Mielolipoma adrenal gigante. Adrenalectomía derecha laparoscópica.

Adrenal myelolipoma is a rare, benign, non-functioning tumor. It is composed by fat and hematopoietic tissues. We present the case of a 33-year-old woman with diagnosis of a 14 cm diameter non-functioning right adrenal incidentaloma, with imaging features suggestive of myelolipoma. Based on the benign nature of the tumor, laparoscopic resection was performed. Histopathology showed a myelolipoma, weighting 444 grams. The patient evolved with an uneventful postoperative period. Laparoscopic adrenalectomy for a giant myelolipoma was feasible and successful.

Mielolipoma adrenal gigante: Adrenalectomía derecha laparoscópica / Giant adrenal myelolipoma. Right laparoscopic adrenalectomy

El mielolipoma es un tumor adrenal poco frecuente. Se trata de un tumor benigno no funcionante compuesto por tejido adiposo y hematopoyético. Presentamos el caso de una paciente de 33 años de edad con diagnóstico de incidentaloma adrenal de 14 cm de diámetro no funcionante. Los estudios imagenológicos presentaban características sugestivas de mielolipoma. Debido a la naturaleza benigna del tumor se decidió el abordaje laparoscópico. La anatomía patológica informó un mielolipoma de 444 gramos. La paciente evolucionó favorablemente en el postoperatorio. El abordaje laparoscópico para la resección del mielolipoma gigante fue factible y exitoso.

Adrenal myelolipoma is a rare, benign, non-functioning tumor. It is composed by fat and hematopoietic tissues. We present the case of a 33-year-old woman with diagnosis of a 14 cm diameter non-functioning right adrenal incidentaloma, with imaging features suggestive of myelolipoma. Based on the benign nature of the tumor, laparoscopic resection was performed. Histopathology showed a myelolipoma, weighting 444 grams. The patient evolved with an uneventful postoperative period. Laparoscopic adrenalectomy for a giant myelolipoma was feasible and successful.

A unique case of synchronous functional adrenocortical adenoma and myelolipoma within the ectopic adrenal cortex in a child with Beckwith-Wiedemann syndrome.

We report a unique case of synchronous functional adrenocortical adenoma and an incidental myelolipoma within ectopic cortical adrenal tissue located in the renal hilum in a child with Beckwith-Wiedemann syndrome and review the association between adrenal gland disorders and myelolipomas. To the best of our knowledge, this is the first documented case of a simultaneous occurrence of these three conditions. A 17-month-old child with Beckwith-Wiedemann syndrome was diagnosed with a left adrenal tumor during complementary radiologic studies. Biochemical investigation before surgery showed elevated blood levels of cortisol and dehydroepiandrosterone hormones. The patient underwent a left adrenalectomy with ipsilateral renal hilar and intercaval-aortic lymph node dissection. Pathology findings revealed a left adrenocortical adenoma and an incidental myelolipoma growing within ectopic cortical adrenal tissue in the renal hilum. The patient is doing well and does not have any current health issues. Patients with adrenal cortex disorders, such as hyperplasias and neoplasms, particularly when associated with hormonal imbalances, may have an increased risk of developing myelolipomas. Whether Beckwith-Wiedemann syndrome may, by itself, contribute to simultaneous occurrence of adrenocortical adenomas and myelolipomas remains to be clarified.

Mielolipoma suprarrenal gigante: reporte de un caso y revisión de la literatura / Giant Adrenal myelolipoma: a case report and literature review

Presentamos un caso de mielolipoma suprarrenal gigante, para ilustrar la expresión y el manejo de esta rara patología. Este tumor benigno poco frecuente, compuesto de tejido hematopoyético maduro y tejido adiposo en proporciones variables, generalmente se diagnostica de forma incidental y sólo tiene indicación quirúrgica en aquellos casos en los que producen síntomas o alcanza grandes dimensiones. Describimos el caso de una paciente de 56 años, asintomática, con el hallazgo incidental de tumor suprarrenal de grandes dimensiones, tratado mediante resección quirúrgica en el servicio de Cirugía III del Hospital Universitario de Caracas

Case report of giant adrenal myelolipoma to describe the presentation and the treatment for this rare entity. This uncommon benign tumor, composed of variables proportions of mature hemopoyetic tissue and fat, is diagnosed incidentally and has indication of surgery only in the few cases in which it turns symptomatic or it reach big dimensions. We report the case of a 56-years-old asymptomatic female, in who is incidentally detected a giant adrenal tumor, surgically resected at the Hospital Universitario de Caracas, Servicio Cirugia III

Mielolipoma gigante: relato de caso e revisão da literatura / Giant myelolipoma: case report and review of the literature

Mielolipomas são tumores benignos raros compostos por tecido adiposo maduro e por elementos hematopoiéticos. Geralmente são menores que 5 cm e assintomáticos, embora lesões maiores podem apresentar-se com dor ou hemorragia retroperitoneal. Descrevemos um caso de mielolipoma gigante, associado à hemorragia retroperitoneal após biópsia por punção com agulha fina

[Adrenal myelolipoma associated with lithiasic cholecystitis, hiatal hernia and esophagitis]. / Mielolipoma adrenal vinculado a colecistitis litiásica, hernia hiatal y esofagitis.

UNLABELLED: The adrenal myelolipoma are rare tumors that are generally asymptomatic, unilateral and nonfunctional and in the majority of the cases they are found incidentally. OBJECTIVE: Is to present a clinical case of adrenal myelolipoma, associated with gallstones. CASE REPORT: A 30 year old obese female with chronic abdominal pain, which underwent a GI series, having found a hiatal hernia and esophagitis. An ultrasound, of the gallbladder and bile ducts showed gallstones and incidentally a tumor of 9.3 x 8 x 7 cm was found between the right kidney and the liver. In the CT of the abdomen of observed, a little vascularized tumor of the adipose composition of 9.2 x 6 x 5 cm over the top of the right kidney. A cholecystectomy was performed and the resection of the tumor, histopathological study of the tumor reported normal adrenal tissues, mature adiposis and hematopoietic with all of its series. CONCLUSIONS: The association of adrenal myelolipoma and gallstones is not common and it could be an incidental association. With the new tools available we can diagnose the adrenal myelolipoma with a greater degree of certainty.