Clinical, radiological and histological features of adrenal myelolipoma: Review and experience with a further eight cases

Objective To review published reports of surgically treated adrenal myelolipomas and report experience with a further eight cases. Patients and methods Eight patients (three men and Jive women, mean age 50.7 years) with adrenal myelolipoma were treated surgically because of the tumour size, symptomatology and/or associated renal pathology. Associated medical problems included hypertension in three patients and diabetes mellitus in one but none of the tumours was endocrinologically active. Results Five patients were diagnosed definitively by abdominal ultrasonography, computed tomography and angiography while the other three were incidentally diagnosed during surgical intervention for ipsilateral renal cell carcinoma in one patient, hydronephrotic kidney in another and multiple renal stones in the third, On pathological examination, the masses removed were surrounded by a thin fibrous capsule and compressed cortical tissue. A cut section was bright yellow with foci of red-brown discoloration. Microscopically, the tumour consisted mainly of mature adipose tissue with scattered islands of haemopoietic cells. There was no operative mortality and no gross morbidity. Conclusion The management of adrenal myelolipoma should be appropriate to each individual case. Operative intervention should be reserved for symptomatic patients or those with large 'silent' tumours that may produce life-threatening shock secondary to spontaneous haemorrhage. Small asymptomatic tumours with definite radiological findings can be followed expectantly.