個案報告：巨型腎上腺骨髓脂肪瘤

陳柏翰¹、陳鈺昕¹、李致樵¹、江百凱¹、林文州¹、陳建志^1,2,3

¹台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院 泌尿科；²馬偕學校財團法人馬偕醫學院；³馬偕學校財團法人馬偕醫護管理專科學校 化妝品應用與管理科

A case report: A huge adrenal myelolipoma

Bo-Han Chen¹, Yu-Xin Chen¹, Chih-Chiao Lee¹, Pai-Kai Chiang¹, Wen-Chou Lin¹, Marcelo Chen^1,2,3

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan¹; School of Medicine, MacKay Medical College, New Taipei City, Taiwan²; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan³

Background:

Adrenal myelolipoma is thought to be a benign tumor composed of mature fat and interspersed hematopoietic elements that resemble bone marrow. It is the benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenoma. [1] Most adrenal myelolipomas are slow growing and the patients with myelolipoma remain asymptomatic. [2] However, mass lesion larger than 6 cm in diameter may cause local mass-effect symptoms and surgical removal should be considered. Here, we shared a case of symptomatic unilateral adrenal myelolipoma and we successfully did transperitoneal adrenalectomy for him.

Case presentation:

A 37-year-old gentleman came to our emergency room with the chief complaint of acute onset chest and abdominal pain for 4 hours. He worked as a cook in the neighborhood of our hospital and denied any other travel, contact or cluster history. The symptoms exacerbated when moving and breathing. Neither cold sweating nor shortness of breath was noted. Most of physically examinations of chest and abdominal at emergency room were normal, except for bilateral costovertebral angle knocking pain and mild right abdominal tenderness were found. Bilateral breathing sound was clean and no chest wall deformity or skin lesion was found. Bowel sound was also normoactive. EKG showed normal sinus rhythm. Lab data showed elevated CRP, mild leukocytosis, elevated creatinine. Urine analysis found discovered numerous leukocytes and 10 erythrocytes under high power field. CT scan showed: (1) A 13.8cm huge mass with fat and soft tissue at right adrenal gland, which was suspicious of myelolipoma complicated with hemorrhage (2) Bilateral hydronephro-ureter. Comparing to his previous image which was taken in our hospital 9 years ago, the maximum diameter of right adrenal tumor increased from 4.7cm to 13.8cm and bilateral renal pelvis were normal at that time. Since the impression of bilateral hydronephrosis and huge right adrenal myelolipoma with hemorrhage, he was admitted for surgical intervention.

Preoperative laboratory data found no abnormality in adrenal related hormone and electrolyte. Potassium was 3.5 and sodium 139.3 mEq/L. ACTH, cortisol, and aldosterone was 35.73 pg/mL, 12.38 μg/dL and 4.86 ng/dL, respectively. Blood pressure was within normal range. Under stable condition, we performed bilateral ureterorenoscopy with double J stent placement for hydronephrosis and right transperitoneal adrenalectomy for the adrenal tumor. Pathologic section showed a huge tumor (17.2 cm in greatest dimension) composed with predominant adipose tissue with infiltrating myeloid component. Degenerative change with hemorrhage was noted. No malignancy is seen on section. Myelolipoma was diagnosed according to above-mentioned features. Postoperative care was smooth without complication. He was discharged at 6 days postoperatively. Outpatient clinic follow-up did not show recurrence until

Conclusion: