Bilateral Giant Myelolipoma of Adrenal Glands A Case Report and Review of the Literature

Adrenal myelolipoma is a rare benign tumor composed of mature adipose cells and hematopoietic elements. Their mostly small size (< 5 cm), unilateral site, and clinical quiescence are accountable for predominantly incidental disclosure. We report a case of a 54-year-old man complaining of gradually aggravating pain in the right hemiabdomen in whom abdominal CT revealed bilateral and giant adrenal masses composed of predominantly adipose tissue with interspersed areas of solid parts displacing the kidneys caudally. The right tumor measured 14 X 9 cm and the left measured 7 cm in diameter. Hormone tests were within normal limits. Right and left adrenalectomies were performed and pathohistologic analysis confirmed diagnosis of myelolipoma. Postoperatively, the patient's recovery and further follow-up was uneventful. Reports on large and bilateral adrenal myelolipomas are very scarce. Current recommendations suggest that in all patients with adrenal incidentalomas, congenital adrenal hyperplasia should be excluded. This is particularly important in myelolipomas since they are occasionally associated with functional adrenal disorders, especially if they are large and bilateral. In adrenal incidentalomas larger than 6 cm a surgical removal is advocated because relatively significant preponderance of malignancy is found.