title: An unusual fat-containing presacral tumor in an elderly patient.
abstract: The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper.
authors.affiliation: Radiology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Maria Inês
authors.identifier: 0000-0003-0187-639X
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Radiology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Afonso
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Pathology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Ferreira
authors.affiliation: Pathology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Santiago
authors.initials: S
authors.lastname: Ortiz
authors.affiliation: Surgery Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Esteves
authors.affiliation: Radiology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Távora