title: Case of combined adrenal cortical adenoma and myelolipoma.
abstract: We report a case of myelolipoma 10 mm in size within a functional cortical adenoma that was 33 x 22 x 17 mm in size. A 29-year-old woman was referred to hospital for transient hypertension. A right adrenal tumor was detected by computed tomography (CT) scan and magnetic resonance imaging (MRI). Her cortisol levels indicated a loss of the normal diurnal pattern, and urinary 17-hydroxycorticosteroids was elevated. She underwent a right adrenalectomy under the diagnosis of adrenal adenoma with Cushing's syndrome. The tumor was fairly well encapsulated by a thin layer of connective tissue. The major tumor portion was composed of two distinct cell types, clear cells and eosinophilic cells, arranged in an alveolar structure. These findings were representative of cortical adenoma. The adrenal cortical adenoma centrally included well-demarcated adipose tissue admixed with scattered islands of myelopoietic elements: erythroblasts, myeloid cell series and lymphocytic cells, which was eventually recognized as myelolipoma. Recently, adrenal myelolipoma has commonly been found because of the ease of detecting it as an incidentaloma by CT scan or MRI. However, the present adrenal myelolipoma case is uncommon because it is combined with a functioning cortical adenoma. Only six similar cases have previously been reported in English and Japanese publications. Furthermore, in the present case, the myelolipoma formed a tumor nodule, and to our knowledge, this is the first reported case of a radiographically recognizable tumor nodule. We discuss the etiology of myelolipoma and suggest that myelolipoma can develop in the course of endocrine hyperfunction.
authors.affiliation: Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan. tmatsuda@med.juntendo.ac.jp
authors.forename: Takaharu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Abe
authors.forename: Masaru
authors.initials: M
authors.lastname: Takase
authors.forename: Atsushi
authors.initials: A
authors.lastname: Arakawa
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Fujime
authors.forename: Koichi
authors.initials: K
authors.lastname: Suda
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018209:Myelolipoma / Q000473:pathology* / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome