J Korean Soc Radiol.  2016 Oct;75(4):296-299. 10.3348/jksr.2016.75.4.296.

Adrenal Myelolipoma Presenting with Spontaneous Rupture and Retroperitoneal Hemorrhage: A Case Report

• Kim DR
• Jung YY
• You MW
• Chun KY
• Hong YO
• Kim DH
• Choi YS
• Woo JJ

• KMID: 2353680
• DOI: http://doi.org/10.3348/jksr.2016.75.4.296

Abstract

Adrenal myelolipoma is a rare, benign, and nonfunctioning tumor, which is generally small and asymptomatic and incidentally discovered at autopsy or on radiological examination. In rare cases, large tumors can produce symptoms due to their mass effect or spontaneous rupture with hemorrhage. We reported a case of a 36-year-old man who presented with retroperitoneal hemorrhage due to spontaneous rupture of a large adrenal myelolipoma discovered using multiple imaging modalities.

MeSH Terms

Adrenal Glands
Adult
Autopsy
Hemorrhage*
Humans
Multidetector Computed Tomography
Myelolipoma*
Rupture
Rupture, Spontaneous*

Figure

• 

  Fig. 1 A 36-year-old man with a ruptured adrenal myelolipoma. A. Ultrasound image shows a well-circumscribed suprarenal mass with internal heterogeneous echogenicity (arrows). B. Axial pre-contrast computed tomography (CT) image shows a well-defined mass containing intratumoral macroscopic fat (black arrow) in the right adrenal bed with an internal high attenuated portion (white arrow), suggestive of hemorrhage. C. Sagittal reformatted contrast-enhanced CT image shows hemorrhage (arrow) along the posterior perinephric space. D. Coronal reformatted contrast-enhanced CT image shows suprarenal location of the right retroperitoneal mass with the inferiorly displaced right kidney (black arrow). The peritumoral hemorrhage extends into the right pelvic retroperitoneum (white arrow). E. Photomicrograph of the tumor mass (hematoxylin & eosin staining, × 100) shows a mixture of mature adipose tissues (black arrow) and hematopoietic elements (white arrow), pushing the adrenal cortex (asterisk). F. Higher magnification of the tumor (hematoxylin & eosin staining, × 200) shows bone marrow cells (black arrow) and adipocytes (white arrow).

Reference

1. Kenney PJ, Wagner BJ, Rao P, Heffess CS. Myelolipoma: CT and pathologic features. Radiology. 1998; 208:87–95.

2. Amano T, Takemae K, Niikura S, Kouno M, Amano M. Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol. 1999; 6:585–588.

3. Lattin GE Jr, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, et al. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics. 2014; 34:805–829.

4. Kumar S, Jayant K, Prasad S, Agrawal S, Parma KM, Roat R, et al. Rare adrenal gland emergencies: a case series of giant myelolipoma presenting with massive hemorrhage and abscess. Nephrourol Mon. 2015; 7:e22671.

5. Lam KY, Lo CY. Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution. J Clin Pathol. 2001; 54:707–712.

6. Alvarez JF, Goldstein L, Samreen N, Beegle R, Carter C, Shaw A, et al. Giant adrenal myelolipoma. J Gastrointest Surg. 2014; 18:1716–1718.

7. Russell C, Goodacre BW, vanSonnenberg E, Orihuela E. Spontaneous rupture of adrenal myelolipoma: spiral CT appearance. Abdom Imaging. 2000; 25:431–434.

8. Gamss C, Chia F, Chernyak V, Rozenblit A. Giant hemorrhagic myelolipoma in a patient with sickle cell disease. Emerg Radiol. 2009; 16:319–322.

9. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008; 190:1163–1168.

10. Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012; 36:75–82.