Myelolipomas and other fatty tumours of the adrenals.

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Abstract

Lipomatous tumours of the adrenals are almost always benign. The importance of recognising their characteristic radiological features, leading to their correct treatment, is fundamental, as there has been an increase in the identification of these lesions. Our goal was to review all lipomatous tumours of the adrenal glands, particularly myelolipomas, their imaging methods and surgical management, updated in 2011.

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Most cited references 41

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Management of the clinically inapparent adrenal mass ("incidentaloma").

Melvin M. Grumbach, Beverly M K Biller, Glenn Braunstein … (2003)

The National Institutes of Health Consensus Development Program convened surgeons, endocrinologists, pathologists, biostatisticians, radiologists, oncologists, and other health care professionals, as well as members of the general public, to address the causes, prevalence, and natural history of clinically inapparent adrenal masses, or "incidentalomas"; the appropriate evaluation and treatment of such masses; and directions for future research. Improvements in abdominal imaging techniques have increased detection of adrenal incidentalomas, and because the prevalence of these masses increases with age, appropriate management of adrenal tumors will be a growing challenge in our aging society. To address six predetermined questions, the 12-member nonfederal, nonadvocate state-of-the-science panel heard presentations from 21 experts in adrenal incidentalomas and consulted a systematic review of medical literature on the topic provided by the Agency for Healthcare Research and Quality and an extensive bibliography developed by the National Library of Medicine. The panel recommended a 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines for all patients with an adrenal incidentaloma; additional measurement of serum potassium and plasma aldosterone concentration-plasma renin activity ratio for patients with hypertension; and surgery for patients with biochemical evidence of pheochromocytoma, patients with tumors greater than 6 cm, and patients with tumors greater than 4 cm who also meet other criteria. The panel also advocated a multidisciplinary approach to managing adrenal incidentalomas. The statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.

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Myelolipoma: CT and pathologic features.

Laurence Kenney, C Heffess, B. Wagner … (1998)

To correlate clinical and pathologic patterns of myelolipoma with the computed tomographic (CT) appearance. All cases of myelolipoma accessioned by the Armed Forces Institute of Pathology from 1981 through 1997 were reviewed. CT images were scored for the location and size of each myelolipoma and the presence of calcification, hemorrhage, fat, and pseudocapsule. Pathologic findings for the pattern of fat and bone marrow elements were correlated with CT findings. In 74 patients, 86 myelolipomas were found, of which 72 were in an adrenal gland (eight were bilateral), and 14 extra-adrenal masses were found in 10 patients. Four clinicopathologic patterns emerged: (a) isolated adrenal myelolipoma in 37 patients (fat evident at CT, no other disorders present); (b) myelolipoma with hemorrhage in nine patients (imaging features similar to those of isolated adrenal myelolipomas but larger [mean diameter, 14.2 vs 9.9 cm; P = .01]; (c) extra-adrenal myelolipoma in 10 patients (imaging findings similar to those of adrenal myelolipomas, found most often in the retroperitoneum); and (d) myelolipomatous foci within other adrenal pathologic conditions in 18 patients (smaller, lower fat content, more heavily calcified). Myelolipomas are adrenal or extra-adrenal masses, with hemorrhage more common in larger lesions (diameter, > 10 cm). The CT appearance of myelolipomatous foci, which can be found within other pathologic adrenal conditions, is different from that of isolated adrenal myelolipomas.

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Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution.

Hugo Lam, Amy Lo (2001)

Fatty tumours of the adrenal gland are uncommon and their features have received little attention in the literature. The aim of this study is to analyse the features of adrenal lipomatous tumours. The histological features of primary adrenal tumours reported over a 30 year period (1970 to 1999) in Queen Mary Hospital, Hong Kong were reviewed and the clinicopathological features of adrenal lipomatous tumours were analysed. Adrenal lipomatous tumours were noted in 20 patients (12 men, eight women), and they accounted for 4.8% of the primary adrenal tumours reported. The adrenal fatty tumours comprised 11 myelolipomas, three lipomas, three teratomas, two angiomyolipomas, and one liposarcoma. Calcification or bone was noted in one third (seven of 20) of the adrenal tumours. In some fatty tumours (myelolipoma and angiomyolipoma), the fatty component may be inconspicuous. This is the first report in the English literature of angiomyolipoma and liposarcoma of the adrenal gland. Different types of fatty tumours were noted in the adrenal gland. A high index of suspicion should be maintained with an aim of surgical treatment for selected patients with large and symptomatic adrenal lipomatous lesions. Histological confirmation is needed for diagnosis.

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Author and article information

Journal

Journal ID (iso-abbrev): Arab J Urol

Title: Arab journal of urology

Publisher: Elsevier BV

ISSN: 2090-598X

ISSN (Print): 2090-598X

Publication date (Electronic): Dec 2011

Volume: 9

Issue: 4

Affiliations

[1 ] American University of Beirut, Division of Urology, Beirut, Lebanon.

Article

Publisher Item ID: S2090-598X(11)00097-0

DOI: 10.1016/j.aju.2011.10.003

PMC ID: 4150587

PubMed ID: 26579309

SO-VID: bee2d9a8-fb09-460d-9d3b-9654eba2fcce

History

Keywords: HU, Hounsfield unit,US, ultrasonography,Myelolipomas,Laparoscopic adrenalectomy,Conservative management,CAH, congenital adrenal hyperplasia,Adrenal glands

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Keywords: HU, Hounsfield unit, US, ultrasonography, Myelolipomas, Laparoscopic adrenalectomy, Conservative management, CAH, congenital adrenal hyperplasia, Adrenal glands

Myelolipomas and other fatty tumours of the adrenals.

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Most cited references 41

Management of the clinically inapparent adrenal mass ("incidentaloma").

Myelolipoma: CT and pathologic features.

Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution.

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