title: Adrenal incidentaloma does it require surgical treatment? Case report and review of literature.
abstract: BACKGROUND
  Adrenal incidentalomas have a prevalence of at least 5% in the general population. Among these adrenal myelolipoma are rare nonfunctioning tumors of adrenal with an incidence of 0.1-0.2% as documented in CT and autopsy series. We report such a rare case of adrenal myelolipoma incidentally detected while evaluating a case of chronic nonspecific flank pain.
  
  
  METHODS
  38-year-old obese female patient, known hypertensive on treatment presented with nonspecific right flank pain since 1 year. Ultrasonography and Computed tomography of the abdomen showed right adrenal gland mass with fat density measuring 6.3cm×6.2cm×5cm. Patient underwent right side adrenalectomy, post operatively patient had an uneventful recovery. Histopathological examination of the specimen revealed features of adrenal myelolipoma.
  
  
  CONCLUSIONS
  Myelolipoma is an uncommon, benign; tumor like lesion composed of mature adipose tissue admixed with hematopoietic cells. Most myelolipomas appear as unilateral adrenal masses. Adrenal myelolipomas are usually small and asymptomatic. CT or MRI detects the areas of gross fat with in the lesion. These tumors can present as acute abdomen following tumor hemorrhage which is more likely in myelolipomas greater than 4cm in size, hence warrants adrenalectomy.
  
  
  CONCLUSIONS
  adrenal myelolipoma are rare benign tumors, incidentally detected on CT. CT or MRI is diagnostic. Large myelolipoma warrants surgery due to the risk of hemorrhage.
authors.affiliation: Department of Surgery, Karnataka Institute of Medical Sciences, Vidyanagar, Hubli 580022, Karnataka, India. Electronic address: d.yalagachin@yahoo.com.
authors.forename: Gurushantappa H
authors.initials: GH
authors.lastname: Yalagachin
authors.forename: Bharath Kumar
authors.initials: BK
authors.lastname: Bhat