罕見巨大腎上腺髓脂瘤於年輕患者：達文西手術切除病例報告

黃國倫¹、吳振宇^1、2、吳俊賢^1、2、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

A Rare Giant Adrenal Myelolipoma in a Young Patient: Robotic Resection Case Report
Allen, Guo-Lun Huang¹, Richard C. Wu^1,2, Chun-Hsien Wu^1,2, Victor C. Lin^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: Adrenal myelolipoma is a rare and benign tumor of the adrenal gland. These tumors are usually asymptomatic and are often discovered incidentally during imaging. However, larger lesions may present with nonspecific symptoms due to mass effect, such as abdominal pain. Surgical intervention with traditional open technique is generally recommended for adrenal myelolipomas exceeding 6 cm in size. This case report describes the clinical presentation, diagnostic workup, and successful robotic resection of a large adrenal myelolipoma in a 26-year-old woman. 

Case report: A 26-year-old female presented with a one-year history of intermittent epigastric pain. She initially sought evaluation from the gastroenterology department, where abdominal ultrasonography revealed an 8 cm hyperechoic lesion (Fig. 1A). The differential diagnosis included liver and adrenal tumors. Serological tests for Hepatitis B and C virus antibodies were negative, and tumor markers such as carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) were within normal limits. Further imaging with abdominal computed tomography (CT) demonstrated a well-defined, fat-containing mass in the right adrenal gland, with punctate calcifications (Fig. 1B). These findings were suggestive of adrenal myelolipoma. The patient was subsequently referred to the urology department for preoperative evaluation. Magnetic resonance imaging (MRI) further confirmed the presence of a right adrenal fat-containing mass, strongly favoring the diagnosis of adrenal myelolipoma. Given the size of the lesion and its potential for mass effect causing symptoms, surgical intervention was recommended. The patient underwent a robotic-assisted laparoscopic right partial adrenalectomy with tumor excision. The procedure was completed in 104 minutes with blood loss of 50 ml. There were no intraoperative or postoperative complications, and the patient’s hospital stay was 4 days. Histopathological analysis confirmed the diagnosis of adrenal myelolipoma, measuring 8.1 × 7.5 × 4.3 cm.

Conclusion: Adrenal myelolipoma, although rare, should be considered in the differential diagnosis of adrenal masses. MRI, CT, and sonography each offer unique insights that together create a comprehensive profile of this rare tumor’s characteristics. Robotic-assisted laparoscopic adrenalectomy provides a minimally invasive approach with excellent outcomes in terms of operative time, blood loss, and recovery.