Multiple Giant Retroperitoneal Myelolipoma: A Case Report and Review of the Literature

Case Report

Sarcoma Res Int. 2020; 5(1): 1044.

Multiple Giant Retroperitoneal Myelolipoma: A Case Report and Review of the Literature

Colarossi C, Picardo C, Di Mattia P, Aiello E, Colarossi L, De Zuanni M and Memeo L*

Department of Experimental Oncology, Mediterranean Institute of Oncology, Italy

*Corresponding author: Memeo L, Department of Experimental Oncology, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, (CT), Italy

Received: May 08, 2020; Accepted: October 09, 2020; Published: October 16, 2020

Abstract

Myelolipoma is an uncommon benign mesenchymal tumor consisting of mature adipocytes and hemopoietic elements mostly found in adrenal glands. Extra-adrenal myelolipoma occurs rarely and requires differential diagnosis with other soft tissue tumors. Here the authors present a case of a 55 years old man who underwent laparotomic surgery for three peri-renal masses. The aim of this report is to present the clinical, radiological and pathological features of an unusual retroperitoneal lesion that still represents a challenging diagnosis.

Keywords: Myelolipoma; Retroperitoneal mass; Liposarcoma

Abbreviations

AM: Adrenal Myelolipoma; ML: Myelolipoma

Introduction

Myelolipomas are rare benign tumor, composed of mature adipose and myeloid tissue, described for the first time by Gierke in 1905 [1] and classified by Oberling in 1929 [2]. They are usually asymptomatic, unilateral, single and located in the adrenal gland [3]. Despite the more frequent adrenal presentation, approximately 15% of myelolipomas can be found in an extra-adrenal location, more frequently in retroperitoneum [4], pelvis [5] and mediastinum [6]. Extra-adrenal myelolipoma may present a diagnostic challenge, especially when origins in retro peritoneum. Fat-containing retroperitoneal lesions require a differential diagnosis with a large number of neoplastic and no neoplastic conditions [7]. Commonly, they may be misidentified as well-differentiated liposarcoma on radiographic imaging given their similar gross morphological composition. We report a rare case of a 55 old man who presented three retroperitoneal nodules, a giant soft tissue tumor with two minor satellite tumors. The presence of three discontinuous nodules was suggestive of liposarcoma. The postoperative histological analysis allowed the diagnosis of myelolipoma.

Case Presentation

A 55 years old white male was admitted in emergency room complaining non-specific left abdominal pain. He was affected by obesity and chronic hypertension. No previous surgery was reported in anamnesis. On physical examination, abdominal palpation demonstrated a left abdominal, painful mass. Therefore, he was admitted in our oncologic surgery and abdominal CT scan was performed, which revealed the presence of three expansive solid masses occupying the left abdomen, the largest with a diameter of 19x13x12cm, and two minor satellite masses, which displaced adjacent organs, compressed the left ureter and encased the left renal artery. All the three masses appeared capsulated, with minimal contrast enhancement and mixed density containing soft tissue enhancement and fatty component (Figure 1). No abdominal lymphadenopathy was described. Laboratory tests at admission gave the following results: blood leukocytes 5,900/mm3 with normal differential cell count; red blood cells 5,470,000/mm3; blood hemoglobin 14.9 g/dl with a Mean Corpuscular Volume (MCV) of 83 fl; blood platelet count 175,000/ mm3; HTC 45.3%. The patient underwent exploratory laparotomy, and the three masses were removed en bloc. The post-operative course was regular and the patient was discharged on the seventh postoperative day. Laboratory tests at discharge: blood leukocytes 4,080/ mm3 with normal differential cell count; red blood cells 4,180,000/ mm3; blood hemoglobin 11.4 g/dl with a Mean Corpuscular Volume (MCV) of 80 fl; and blood platelet count 152,000/mm3; HTC 33,6%.