Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3431–3435 | Cite as

Giant Retroperitoneal Myelolipoma: An Unusual Diagnostic GI Challenge—Case Report and Review of the Literature

  • G. Vigutto
  • A. LauroEmail author
  • S. Vaccari
  • M. G. Pirini
  • M. Diegoli
  • V. D’Andrea
  • I. R. Marino
  • M. Cervellera
  • V. Tonini



Myelolipomas are rare, benign neoplasms usually arising from the retroperitoneum. They represent an unusual diagnostic challenge due to their vague GI symptoms. We present a case of an 81-year-old patient complaining of severe dyspepsia. An abdominal CT scan and a fine needle biopsy lead to a diagnosis of giant retroperitoneal myelolipoma. A complete surgical resection was performed; no evidence of recurrent tumor was noted after 10 months.

Areas Covered

Giant myelolipomas are very rare lesions. Clinical diagnosis of myelolipomas can be problematic due to their indefinite symptoms. CT scan and fine needle biopsy can be useful to reach a diagnosis, although they cannot be used to exclude malignancy in giant lesions. Surgery is the principal treatment if the tumor is symptomatic or > 7 cm. Follow-up is not mandatory due to the lack of any example of recurrence described in literature.

Expert Commentary

Despite the size of the neoplasms, since most of the complaints are vague, patients with this diagnosis should be considered among patients with unexplained gastrointestinal symptoms. Since malignancy cannot be excluded based on preoperative and intraoperative biopsy, an aggressive surgical approach is essential.


Myelolipoma Retroperitoneum Surgery Dyspepsia 



Adrenocorticotropic hormone


Computed tomography


Mouse double minute 2 homolog


Magnetic resonance imaging




Cyclin-dependent kinase 4


Fluorescence in situ hybridization


Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflicts of interest pertaining to this work.


  1. 1.
    Lazarides AL, Scott EJ, Cardona DM, et al. Simultaneous primary presacral myelolipomas: case report and review of the literature. J Gastrointest Cancer. 2016;47:331–335.CrossRefGoogle Scholar
  2. 2.
    Dan D, Bahadursingh S, Hariharan S, et al. Extra-adrenal perirenal myelolipoma: a case report and review of literature. G Chir. 2012;33:62–65.PubMedGoogle Scholar
  3. 3.
    Lee JJ, Dickson BC, Sreeharsha B, et al. Presacral myelolipoma: diagnosis on imaging with pathologic and clinical correlation. AJR. 2016;207:470–481.CrossRefGoogle Scholar
  4. 4.
    Fourati H, Fourati M, Hentati Y, et al. Presacral myelolipoma: imaging features. Elsevier Masson SAS. 2015;44:1196–1198.Google Scholar
  5. 5.
    Lam AK. Lipomatous tumours in adrenal gland: WHO updates and clinical implications. Endocr-Relat Cancer. 2017;24:65–79.CrossRefGoogle Scholar
  6. 6.
    Pillay Y. Abdominal wall extra-adrenal myelolipoma, a case report and review of the literature. J Surg Case Rep. 2018;4:1–4.CrossRefGoogle Scholar
  7. 7.
    Abbas SH, Goyal G, Yu K, et al. An incidental finding of extra-adrenal myelolipoma in the upper abdominal cavity attached to mesentery: a rare case. Cureus. 2019;11:e4830.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Yildiz BD. Giant extra-adrenal retroperitoneal myelolipoma with incidental gastric mesenchymal neoplasias. Int Surg. 2015;100:1018–1020.CrossRefGoogle Scholar
  9. 9.
    Nakayama Y, Matayoshi N, Akiyama M, et al. Giant adrenal myelolipoma in a patient without endocrine disorder: a case report and a review of the literature. Case Rep Surg. 2018;2018:4854368.Google Scholar
  10. 10.
    Akamatsu H, Koseki M, Nakaba H, et al. Giant adrenal myelolipoma: report of a case. Surg Today. 2004;34:283–285.CrossRefGoogle Scholar
  11. 11.
    Wilhelmus JL, Schrodt GR, Alberhasky MT, et al. Giant adrenal myelolipoma: case report and review of the literature. Arch Pathol Lab Medicine. 1981;105:532–535.Google Scholar
  12. 12.
    Mukherjee S, Pericleous S, Hutchins RR, et al. Asymptomatic giant adrenal myelolipoma. Urol J. 2010;7:66–68.PubMedGoogle Scholar
  13. 13.
    Kumar S, Jayant K, Prasad S, et al. Rare adrenal gland emergencies: a case series of giant myelolipoma presenting with massive hemorrhage and abscess. Nephro-Urol Mon. 2015;7:e22671.CrossRefGoogle Scholar
  14. 14.
    Brogna A, Scalisi G, Ferrara R, et al. Giant secreting adrenal myelolipoma in a man: a case report. J Med Case Rep. 2011;5:298.CrossRefGoogle Scholar
  15. 15.
    O’Daniel-Pierce ME, Weeks JA, Mcgrath PC. Giant adrenal myelolipoma. South Med J. 1996;89:1116–1118.CrossRefGoogle Scholar
  16. 16.
    Reshi R, Bhat ML, Kadri SM, et al. Giant myelolipoma of the adrenal gland with adenocarcinoma of the colon: a rare surgico-pathological presentation. Lab Med. 2007;38:491–492.CrossRefGoogle Scholar
  17. 17.
    Gautam SC, Raafat H, Sriganesh S, et al. Giant adrenal myelolipoma. Qatar Med J. 2013;1:2–11.CrossRefGoogle Scholar
  18. 18.
    Tanaka D, Oyama T, Niwatsukino H, et al. A case of asymptomatic giant myelolipoma of the adrenal gland. Radiat Med. 1998;16:213–216.PubMedGoogle Scholar
  19. 19.
    Dell’Avanzato R, Castaldi F, Giovannini C, et al. Giant symptomatic myelolipoma of the right adrenal gland: a case report. Chir Italiana. 2009;61:231–236.Google Scholar
  20. 20.
    Saha M, Dasgupta S, Chakrabarti S, et al. Giant myelolipoma of left adrenal gland simulating a retroperitoneal sarcoma. Int J Adv Med Health Res. 2015;2:122–125.CrossRefGoogle Scholar
  21. 21.
    Gupta K, Kalra N, Das R, et al. A rare association of giant adrenal myelolipoma in a young female double heterozygous for HbD Punjab and β-thalassemia trait. Indian J Pathol Microbiol. 2011;54:635–637.CrossRefGoogle Scholar
  22. 22.
    Gerson G, Beco MPFG, Hirth CG, et al. Giant retroperitoneal myelolipoma: case report and literature review. J Bras de Patologia e Med Lab. 2015;51:1.Google Scholar
  23. 23.
    Takahashi H, Yamaguchi T, Takeda R, et al. A case of giant adrenal myelolipoma. J Jpn Surg Assoc. 2005;66:197–201.CrossRefGoogle Scholar
  24. 24.
    Fernandes GC, Gupta RK, Kandalkar BM. Giant adrenal myelolipoma. Indian J Pathol Microbiol. 2010;53:325–326.CrossRefGoogle Scholar
  25. 25.
    Chand G. Giant adrenal myelolipoma presenting as an incidentaloma: a case report and review of literature. J Investig Genom. 2017;4:35–37.Google Scholar
  26. 26.
    Répassy DL, Csata S, Sterlik G, et al. Giant adrenal myelolipoma. Pathol Oncol Res. 2001;7:72–73.CrossRefGoogle Scholar
  27. 27.
    Anderson BB, Hampton LJ, Johnson CM, et al. Symptomatic giant adrenal myelolipoma. World J Endocr Surg. 2010;2:143–144.CrossRefGoogle Scholar
  28. 28.
    Goldman HB, Howard RC, Patterson AL. Spontaneous retroperitoneal hemorrhage from a giant adrenal myelolipoma. J Urol. 1996;155:639.CrossRefGoogle Scholar
  29. 29.
    Ersoy E, Ozdogan M, Demirag A, et al. Giant adrenal myelolipoma associated with small bowel leiomyosarcoma: a case report. Turk J Gastroenterol. 2006;17:126–129.PubMedGoogle Scholar
  30. 30.
    Chakrabarti I, Ghosh N, Das V. Giant adrenal myelolipoma with hemorrhage masquerading as retroperitoneal sarcoma. J Mid-life Health. 2012;3:42–44.CrossRefGoogle Scholar
  31. 31.
    Boudreaux D, Waisman J, Skinner DG, et al. Giant adrenal myelolipoma and testicular interstitial cell tumor in a man with congenital 21-hydroxylase deficiency. Am J Surg Pathol. 1979;3:109–123.CrossRefGoogle Scholar
  32. 32.
    McGeoch SC, Olson S, Krukowski ZH, et al. Giant bilateral myelolipomas in a man with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2012;97:343–344.CrossRefGoogle Scholar
  33. 33.
    Kale G, Pelley EM, Davis DB. Giant myelolipomas and inadvertent bilateral adrenalectomy in classic congenital adrenal hyperplasia. Endocrinol Diabetes Metabol Case Rep. 2015;2015:150079.Google Scholar
  34. 34.
    Alvarez JF, Goldstein L, Samreen N, et al. Giant adrenal myelolipoma. J Gastrointest Surg. 2014;18:1716–1718.CrossRefGoogle Scholar
  35. 35.
    Al-Bahri S, Tariq A, Lowentritt B, et al. Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia. Case Rep Surg. 2014;2014:728198.PubMedPubMedCentralGoogle Scholar
  36. 36.
    German-Mena E, Zibari GB, Levine SN. Adrenal myelolipomas in patients with congenital adrenal hyperplasia: review of the literature and a case report. Endocr Pract. 2011;17:441–447.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • G. Vigutto
    • 1
  • A. Lauro
    • 1
    Email author
  • S. Vaccari
    • 1
  • M. G. Pirini
    • 2
  • M. Diegoli
    • 3
  • V. D’Andrea
    • 4
  • I. R. Marino
    • 5
  • M. Cervellera
    • 1
  • V. Tonini
    • 1
  1. 1.Surgery Emergency DepartmentSt. Orsola University HospitalBolognaItaly
  2. 2.Pathological Anatomy DepartmentSt. Orsola University HospitalBolognaItaly
  3. 3.Preventive and Diagnostic Medicine DepartmentSt. Orsola University HospitalBolognaItaly
  4. 4.Department of Surgical Sciences, Umberto I HospitalLa Sapienza UniversityRomeItaly
  5. 5.Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations