Case report of a 60-year-old male with giant adrenal myelolipoma

Abstract

Adrenal myelolipoma is a benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma, following adrenocortical adenomas. It is composed of elements of adipose tissue and with varying amounts of hematopoietic components. In the past, these tumors were discovered at autopsy, with an incidence ranging from 0.08% to 0.4%. Today, with the widespread use of radiological studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), the incidental detection of myelolipoma has become more common, constituting up to 10-15% of incidental adrenal masses. The patient was hospitalized for a 3-month history of discomfort in the right flank, swelling over the right hypochondriac area, constipation, retrosternal burning sensation, and early satiety. His vitals were stable but per abdominal examination revealed a mass in the right hypochondrium. B-mode ultrasound screening revealed an adrenal tumor. A hematological examination revealed thrombocytopenia. The presence of unilateral adrenal mass with the absence of new-onset hypertension with CECT suggestive of mixed tissue density mass with multiple ill-defined heterogeneously hypodense fat attenuation led to the primary diagnosis of an adrenal mass After correction of thrombocytopenia, the mass was excised and subjected to histological evaluation. The histological study results corroborated with the original diagnosis of unilateral adrenal myelolipomas. The patient was followed up for 2 months postoperatively and was found to be relieved from the presenting symptoms with no postoperative complications. Adrenal myelolipoma is an uncommon, benign, and hormonally inactive adrenal gland tumor. It may present with symptoms due to compression of adjacent structures which warrants a surgical excision.