Introduction: Adrenal myelolipomas and lipomas are extremely rare benign tumors. They are usually asymptomatic and in most cases are incidentally found at radiological examinations or autopsy. Symptoms such as abdominal pain and increasing girth occur only when the tumor grows large. Objectives: To evaluate and treat this situation. Subjects: We report the case of a giant adrenal myelolipoma with dimensions of 9 x 8 x 8cm and a giant adrenal lipoma with dimensions of 20 x16 x 12cm. Firstly, in a 48 year old man admitted to hospital on the 18 January 2005 without symtoms of adrenal lipoma or adrenal mylolipoma and another one is a 25 year old man who was hospitalized on the 8 December, 2004 with pain in the right hip since two months prior, normal blood pressure and undiscovered tumor by hand. Result: Other tests were normal. Looking at the CT scan images, a dark and consistent block located between the liver and right kidney can be seen. It pushed and turned the right kidney. Both of them were resected by laparoscopy. Conclusion: We discuss the prevalence, clinical features, diagnosis and treatment of these uncommon tumors.
Adrenal myelolipoma and lipoma

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible. METHODS: Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years. RESULTS: Of the 21 patients (mean age, 56+/-12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4x1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred. CONCLUSIONS: EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.
Adrenal Glands* ; Biopsy, Fine-Needle* ; Carcinoma, Hepatocellular ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Fever ; Granuloma ; Histoplasmosis ; Humans ; Lipoma ; Lung ; Myelolipoma ; Neoplasm Metastasis ; Prospective Studies ; Tuberculosis

Adrenal myelolipoma is an uncommon non-functioning tumor that is composed of variable amounts of mature adipose tissue and scattered islands of hematopoietic elements, including erythroid, myeloid, lymphoid series, and megakaryocytes. Adrenal myelolipoma should be differentiated from other fat-containing adrenal masses, such as teratoma, lipoma, and liposarcoma. This case report describes a 50-year-old adult who was raised as a male and developed giant adrenal myelolipomas that presented as symptomatic adrenal masses, and which were misdiagnosed as liposarcoma on radiologic examination. The patient had been raised as a male despite ambiguous genitalia, and a thorough investigation was never carried out because of his poor socioeconomic status. Physical examination showed profound short stature (<-3.0 standard deviation score), hyperpigmentation, and a micropenis without palpable gonads. Both a uterus and ovaries were evident in the pelvic cavity on abdominopelvic computed tomography. Adrenocorticotropic hormone stimulation tests confirmed adrenal insufficiency. Steroid replacement therapy was initiated before bilateral adrenalectomy and the histologic findings indicated myelolipoma. The patient's karyotype was 46, XX and mutation analysis of the CYP21A2 gene identified compound heterozygosity consisting of p.I173N and p.Q319*. The patient was treated with once-daily 0.5 mg dexamethasone and once-daily 0.1 mg fludrocortisone. Because the subject had been raised as a male, additional procedures such as an oophorohysterectomy are currently under consideration. We here describe an adrenal myelolipoma in this case that was complicated by a 21-hydroxylase deficiency. We conclude from our analysis that patients with congenital adrenal hyperplasia should be screened for incidental adrenal masses to avoid unnecessary surgical procedures.
Adipose Tissue ; Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; Adrenalectomy ; Adrenocorticotropic Hormone ; Adult ; Dexamethasone ; Disorders of Sex Development ; Female ; Fludrocortisone ; Genital Diseases, Male ; Gonads ; Humans ; Hyperpigmentation ; Islands ; Karyotype ; Lipoma ; Liposarcoma ; Male ; Megakaryocytes ; Myelolipoma ; Ovary ; Penis ; Physical Examination ; Social Class ; Steroid 21-Hydroxylase ; Teratoma ; Uterus