A case of adrenal myelolipoma: A rare encounter requiring specific approach in diagnosis and management

Introduction: Myelolipoma is a rare, benign and non-functional tumor that predominantly develops in the adrenal gland. Case Report: A 71-year-old man presented with large and symptomatic myelolipoma that indicated surgery for symptomatic relieve and definite diagnosis. Hormonal testing was negative for functioning adrenal tumors. Since the patient had moderate renal failure; contrast studies were avoided. Computed tomography (CT) scan showed 6×6 cm well circumscribed left adrenal mass with adipose tissue (very low CT density) and foci of calcifications. 18F-FDG-positron-emission tomography (PET)/CT scanning showed hypermetabolic activity limited to the tumor rim. Macroscopic examination showed foci of hemorrhage, necrosis and cystic degeneration with calcifications. Microscopic examination showed mature adipose tissue admixture with an extramedullary trilinear hematopoiesis without atypia of sarcomata and smooth muscle elements akin to angiomyolipomata. Conclusion: The diagnosis of myelolipoma requires hormonal testing, CT/magnetic resonance imaging (MRI) scans and PET study with individualized management tailored to each case.