罕見病例報告: 腎上腺皮質腺瘤伴隨骨髓脂肪瘤樣病變

張君愷、錢祖明

高雄醫學大學附設中和紀念醫院 泌尿部

Rare case report: Adrenal cortical adenoma with myelolipomatous change

Chun-Kai Chang、Tsu-Ming Chien

Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

Adrenal incidentaloma refers to the discovery of a mass or tumor in the adrenal gland incidentally, usually during imaging tests performed for other reasons. Most are benign and asymptomatic, but some may require further evaluation and management due to their size, characteristics, or hormone secretion. Management depends on the individual case and may involve periodic imaging, surgical intervention, or other treatments.

Our case was a 62-year-old female with systemic lupus erythematosus. A 2cm left adrenal incidentaloma was noted during abdomen CT scan. Mixed fat and soft tissue in the left adrenal gland were noted and differential diagnosis were myelolipoma or collision tumor. After well discussed with patient, surgery was recommended. The laparoscopic surgery was performed through a retroperitoneal approach, left adrenal tumor with normal adrenal gland were noted and then removed adrenal tumor by harmonic scalpel. After that the pathology revealed adrenal cortical adenoma with myelolipomatous change. Microscopic Examination demonstrated adrenal cortical adenoma composed of vacuolated cells and eosinophilic cells arranged in nests, cords and trabeculae. Myelolipomatous change is noted. Immunostains show inhibin(+), synaptophysin(+), Melan-A(+). No specific discomfort or complication was noted after operation, and then the patient discharged on post-operative day 3.

Adrenal cortical adenoma with myelolipomatous change is a rare type of adrenal tumor, characterized by the presence of both adrenal cortical cells and mature adipose tissue mixed with hematopoietic cells. Adrenal tumors with myelolipomatous change may show heterogeneous appearance and could mimic malignancy even using advanced radiologic studies. It is usually benign and asymptomatic, but occasionally can cause hormonal abnormalities or compression symptoms. Diagnosis is made through imaging tests and histopathology. Treatment is typically observation, with surgery reserved for larger tumors or those causing symptoms.