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Case of the Month

by Dr K C Choy AM (Mal), MBBS, M.Med, FRCR

Answer to Case Of the Month 

Discussion
The CT scan shows a well defined mass in the left suprarenal region. The mass is retroperitoneal in location as evidenced by the anterior displacement of the pancreatic body and tail as well as part of the stomach. The celiac axis is also stretched and displaced slightly to the right.

The mass is of mixed density with soft tissue and fat component (negative H.U.). There is no calcification or cystic component. The features indicate a retroperitoneal tumour most likely arising from the left adrenal gland. Fatty tissue within a mass may be seen in a variety of tumours such as teratomas, lipoma/liposarcoma, angiomyolipomas, and myelolipoma.

At surgery, a well encapsulated suprarenal tumour was removed. Histopathological examination showed areas of fatty  and haemopoietic tissue and a diagnosis of Adrenal myelolipoma was made.

 

Adrenal myelolipoma
Adrenal myelolipoma is a benign tumour of the adrenal cortex and are composed of mature adipose cells and haemopoietic  tissue. They represent metaplastic overgrowth from stem cells which myelolipomatous and adrenocortical cells share as a common origin.

The gross appearance resembles fatty tissue and contains patchy red brown areas of haemopoietic cells. The tumours are not normally not active hormonally and usually detected incidentally. They are usually seen in the 4th to 6th decades of life and have no sex predilection. Although retroperitoneal haemorrhage has been reported, patients are generally asymptomatic. A small percentage are bilateral and calcifications are occasionally seen.



 

 
About the Author 
Dr K C Choy is currently attached to the Mahkota Medical Centre, Melaka as Radiologist.

 

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Thursday, 21 August, 2003