Endocrine Pathology

, Volume 14, Issue 1, pp 93–100 | Cite as

An unusual case of multiple giant myelolipomas: Clinical and pathogenetic implications

  • Kimberly H. Allison
  • Gary N. Mann
  • Thomas H. Norwood
  • Brian P. Rubin
Case Report


Myelolipomas are benign tumors composed of both mature adipose and myeloid tissues. They typically present as an incidental mass in one of the adrenal glands proper. However, they can occur in ectopic adrenal tissue or, rarely, without associated adrenal tissue in various locations and can grow to weights of several kilograms. These tumors have been linked to endocrinopathies, such as Cushing disease and congenital adrenal hyperplasia, which involve overproduction of adrenocorticotropic hormone. We report a case of three giant adrenal myelolipomas arising in a persistently virilized female with congenital adrenal hyperplasia, supporting a role for hormonal stimuli in myelolipoma formation.

Key Words

Myelolipoma adrenal myelolipoma congenital adrenal hyperplasia adrenal gland tumors ectopic adrenal cytogenetics 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Meaglia JP, Schmidt JD. Natural history of an adrenal myelolipoma. J Urol 147: 1089–1090, 1992.PubMedGoogle Scholar
  2. 2.
    Lam KY, Lo CY. Adrenal lipomatous tumors: a 30 year clinico-pathological experience at a single institution. J Clin Pathol 54:707–712, 2001.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Plaut A. Myelolipoma in the adrenal cortex (myeloadipose structures). Am J Pathol 34:487–503, 1958.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Bordreaux D, Waisman J, Skinner DG, Low R. Giant adrenal myelolipoma and testicular interstitial cell tumor in a man with 21-hydroxylase deficiency. Am J Surg Pathol 3:109–123, 1979.CrossRefGoogle Scholar
  5. 5.
    Gringnon DJ, Shkrum MJ, Smout MS. Extradrenal myelolipoma. Arch Pathol Lab Med 113:52–54, 1989.Google Scholar
  6. 6.
    Shapiro JL, Goldblum JR, Dobrow DA, Ratliff NB. Giant bilateral extra-adrenal myelolipoma. Arch Pathol Lab Med 119:283–285, 1995.PubMedGoogle Scholar
  7. 7.
    Foster JBT. Primary thoracic myelolipoma: case report. Arch Pathol 65:295–297, 1958.Google Scholar
  8. 8.
    Strimlan CV, Khasnabis S. Primary mediastinal myelolipoma. Cleve Clin J Med 60:69–71, 1993.CrossRefPubMedGoogle Scholar
  9. 9.
    Gonzalez EM, Gonzalez JBS, Martinez JB, et al. Hepatic myelolipoma: new case and review of the literature. Hepato-gastroenterology 38:60–63, 1991.Google Scholar
  10. 10.
    Wagner JR, Kleiner DE, Walther MM, Linehan WM. Perirenal myelolipoma. Urology 49:128–130, 1997.CrossRefPubMedGoogle Scholar
  11. 11.
    Brietta LK, Watkins D. Giant extra-adrenal myelolipoma. Arch Pathol Lab Med 118:188–190, 1994.PubMedGoogle Scholar
  12. 12.
    Le Bodic MF, Mussini-Montpellier J, Magois JY, Lepere J. Myelolipoma a localization gastrique. Arch Anat Pathol 22:119–122, 1974.Google Scholar
  13. 13.
    Cina SJ, Gordon BM, Curry NS. Ectopic adrenal myelolipoma presenting as a splenic mass. Arch Pathol Lab Med 119:561–563, 1995.PubMedGoogle Scholar
  14. 14.
    Nalesnik MA, Martinez AJ, Heros RC. Intracranial lipoma with hematopoietic elements (myelolipoma): report of a case with successful surgical resection. Cancer 50:295–299, 1982.CrossRefPubMedGoogle Scholar
  15. 15.
    Hunter SB, Schemankewitz EH, Patterson C, Varma VA. Extraadrenal myelolipoma: a report of two cases. Am J Clin Pathol 97:402–404, 1992.PubMedGoogle Scholar
  16. 16.
    Lockhart ME, Smith JK, Kenney PJ. Imaging of adrenal masses. Eur J Radiol 41: 95–112, 2002.CrossRefPubMedGoogle Scholar
  17. 17.
    Evans GW, Olinde HD, Kozdereli E. Extra-adrenal myelolipoma: a lesion that can be diagnosed by fine needle aspiration biopsy. Acta Cytol 34:536–538, 1990.PubMedGoogle Scholar
  18. 18.
    Lack EE. Congenital adrenal heterotopia, hyperplasia and Beckwith-Wiedemann syndrome. In: Atlas of tumor pathology: tumors of the adrenal gland and extra-adrenal paraganglia, 3rd series, fascicle 19. Washington, DC: Armed Forces Institute of Pathology, 1997; 33–48.Google Scholar
  19. 19.
    Graham LS. Celiac accessory adrenal glands. Cancer 8:143–150, 1955.CrossRefGoogle Scholar
  20. 20.
    Fowler MR, Alba JM, Williams RB, Byrd CR. Extra-adrenal myelolipomas compared with extramedullary hematopoietic tumors: a case of presacral myelolipoma. Am J Surg Pathol 6:363–374, 1982.CrossRefPubMedGoogle Scholar
  21. 21.
    Seyle H, Stone H. Hormonally induced transformation of adrenal gland into myeloid tissue. Am J Pathol 26:211–233, 1950.Google Scholar
  22. 22.
    Rubin BP, Dal Cin P. The genetics of lipomatous tumors. Semin Diagn Pathol 18:286–293, 2001.PubMedGoogle Scholar
  23. 23.
    Umpierrez MB, Fackler S, Umpierrez GE, Rubin J. Adrenal myelolipoma associated with endocrine dysfunction: review of the literature. Am J Med Sci 314:338–341, 1997.PubMedGoogle Scholar
  24. 24.
    Cutler GB Jr, Laue L. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. N Engl J Med 323:1806–1813, 1990.CrossRefPubMedGoogle Scholar
  25. 25.
    Amin MB, Tickoo SK, Schultz D, Amin MB. Myelolipoma of the renal sinus: an unusual site for a rare extra-adrenal lesion. Arch Pathol Lab Med 123:631–634, 1999.PubMedGoogle Scholar
  26. 26.
    Murakami C, Ishibashi M, Kondo M, et al. Adrenal myelolipoma associated with congenital adrenal 21-hydroxylase deficiency. Intern Med 31:803–806, 1992.CrossRefPubMedGoogle Scholar
  27. 27.
    McEven CD, Selye H. Histological changes in the adrenals of tumor bearing rats. Am J M Sc 189:423–424, 1935.CrossRefGoogle Scholar
  28. 28.
    Jaresch S, Kornely E, Kley HK, Schlaghecke R. Adrenal incidentaloma and patients with homozygous or heterozygous congenital adrenal hyperplasia. J Clin Endocrinol Metab 74:685–689, 1992.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2003

Authors and Affiliations

  • Kimberly H. Allison
    • 1
  • Gary N. Mann
    • 2
  • Thomas H. Norwood
    • 1
  • Brian P. Rubin
    • 1
  1. 1.Department of Anatomic PathologyUniversity of Washington Medical CenterSeattle
  2. 2.Department of SurgeryUniversity of Washington Medical CenterSeattle

Personalised recommendations