DX: Large Adrenal Myelolipoma

This could have another diagnosis if would had clear symptoms.  CT findings are consistent with a large right circumscribed adrenal mass with free borders and with predominantly fat content (Hounsfield units range from -75 to -122). It has some inner higher attenuations from glandular tissue but no calcifications.

Here are two spot images:

If patient were to have symptoms, an Adrenal adenoma has to be considered but take in consideration also Retroperitoneal Liposarcoma, Pheocromocytoma, and Adrenocortical Carcinoma. Usually, all of those mentioned have other concerning imaging features but not like this case. This has benign features.

These tumours were initially described by Giercke in 1905, and 24 years later, Oberling coined the team ‘myelolipoma’. Its inner content are of mature adipocytes and normal haematopoietic tissue. Although they do not represent a hematopoietic source, they contain precursors of white and red blood cells such as megakaryocytes.

Adrenal myelolipomas can be a site of extramedullary haematopoiesis. Although great numbers of incidentally discovered lesions are small and asymptomatic, reports in literature are not uncommon for cases of large symptomatic lesions such as this case. The most well-recognised complication of adrenal myelolipoma is spontaneous retroperitoneal haemorrhage but there is still some debate in management on whether needs surgical treatment if asymptomatic. Large myelolipomas tend to bleed so, surgical management is recommended in this case.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843128/

http://emedicine.medscape.com/article/376700-overview#a20

http://www.casesjournal.com/content/2/1/8414


 Thank you for your comments on this case.

CASE 41: 29 y/o female patient with gastric problems

Patient reffered that she had gastic reflux (GERD) and was treated with proton pump inhibitors. She had some pain in the right upper quadrant and therefore was performed an hepatic US.

Findings of US (not shown) revealed a mass but in order to better assesment was reffered to us for an abdominal CT.

Here are the relevant images:

 

 

She had no other relevant symptoms or associated disease.

Findings?...later on, the conclusion.