RESUMO

BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.

Assuntos

RESUMO

Adrenal myelolipomas are rare benign tumors, often non-functioning, located in the adrenal cortex, consisting mainly of mature adipose tissue and hematopoietic tissue. Although uncommon, the number of reported cases has increased due to the greater use of diagnostic imaging techniques. This tumor is usually unilateral and found as an adrenal incidentaloma, although there is a predominance of bilaterality in patients with congenital adrenal hyperplasia (CAH). In this study, we report the case of a 33-year-old male patient with CAH due to 21-hydroxylase deficiency, in non-regular use of the control medication, with bilateral giant adrenal myelolipoma and subsequent evolution of bilateral testicular adrenal rest tumors. He underwent bilateral adrenalectomy by video laparoscopy. The anatomopathological analysis, which confirmed myelolipomas' diagnosis, revealed the right adrenal with 430 g and 12.5 x 9.3 cm and the left with 257 g and 11.5 x 10.4 cm. This tumor may be accompanied by adrenocortical adenoma and carcinoma, ganglioneuroma, pheochromocytoma, Addison's disease, Cushing's syndrome, or CAH. Among the hypotheses of its pathogenesis, we highlight an association between the development of adrenal myelolipoma and chronic hormonal stimulation by the adrenocorticotrophic hormone (ACTH), especially in CAH. The non-regular treatment of CAH with glucocorticoids may have contributed to the chronic and elevated secretion of ACTH and, consequently, to the development of bilateral giant adrenal myelolipoma (AU).

Mielolipomas adrenais são tumores benignos raros, com frequência não-funcionantes, localizados no córtex da adrenal, constituídos, principalmente, por tecido adiposo maduro e tecido hematopoético. Apesar de incomum, o número de casos relatados tem aumentado devido ao maior uso de técnicas diagnósticas de imagens. Esse tumor é geralmente unilateral e encontrado como um incidentaloma adrenal, embora haja predominância de bilateralidade em casos de portadores de hiperplasia adrenal congênita (HAC). Neste estudo, relatamos o caso de um paciente do sexo masculino, de 33 anos, portador de HAC por deficiência de 21-hidroxilase, em uso não-regular da medicação de controle, com mielolipoma adrenal gigante bilateral e posterior evolução de tumor bilateral testicular de restos de adrenais. Ele foi submetido à adrenalectomia bilateral por videolaparoscopia. A análise anátomo-patológica, que confirmou o diagnóstico de mielolipomas, revelou adrenal direita com 430 g e 12,5 x 9,3 cm, e esquerda com 257 g e 11,5 x 10,4 cm. Esse tumor pode vir acompanhado de adenoma e carcinoma adrenocortical, glanglioneuroma, feocromocitoma, doença de Addison, Síndrome de Cushing ou HAC. Dentre as hipóteses de sua patogênese, des-tacamos uma associação entre o desenvolvimento do mielolipoma adrenal e a estimulação hormonal crônica pelo hormônio adrenocorticotrófico (ACTH), especialmente na HAC. O tratamento não-regular da HAC com glicocorticoides pode ter contribuído para a secreção crônica e elevada de ACTH e, consequentemente, para o desenvolvimento do mielolipoma adrenal gigante bilateral (AU).

Assuntos

RESUMO

Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

RESUMO

Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomography and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en estudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia magnética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Assuntos

RESUMO

Introducción: Los tumores de la glándula suprarrenal son inusuales y por lo general son hallados de forma incidental por estudios de imágenes. Dentro de este grupo los mielolipomas son uno de los tumores más raros, considerados el 2% de los tumores suprarrenales. Caso Clínico: Presentamos una paciente femenina de 60 años de edad con antecedentes de dolor a tipo cólico de forma esporádica a nivel del hipocondrio derecho. La ecografía abdominal detectó colelitiasis y una masa sugerente de adenoma suprarrenal izquierdo. La tomografía abdominal corroboró el tumor suprarrenal gigante y la litiasis vesicular. Se realizó suprarrenalectomía y colecistectomía convencional sin complicaciones. El diagnóstico histopatológico mostró un mielolipoma suprarrenal y una colecistitis crónica. Discusión: El mielolipoma suprarrenal es infrecuente, la etiología se desconoce, por lo general es asintomático y su hallazgo es incidental, habitualmente son unilaterales, menores a 4cm y la incidencia aumenta con la edad. Conclusiones: Cuando los mielolipomas alcanzan dimensiones mayores de 10cm se recomienda realizar una suprarrenalectomía convencional.

Introduction: Adrenal gland tumors are unusual and are usually found incidentally by imaging studies. Within this group, myelolipomas are one of the rarest tumors, considered 2% of adrenal tumors. Clinical case: We present a 60-year-old female patient with a history of sporadically colicky pain at the level of the right hypochondrium. Abdominal ultrasound revealed cholelithiasis and a mass suggestive of a left adrenal adenoma. Abdominal tomography confirmed a giant adrenal tumor and gallstones. An adrenalectomy and conventional cholecystectomy were performed without complications. The histopathological diagnosis showed an adrenal myelolipoma and chronic cholecystitis. Discussion: Adrenal myelolipoma is infrequent, the etiology is unknown, it is usually asymptomatic and its finding is incidental, they are usually unilateral, smaller than 4cm and the incidence increases with age. Conclusions: When myelolipomas reach dimensions greater than 10cm, conventional adrenalectomy is recommended. In selected cases.

RESUMO

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications.

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Assuntos

RESUMO

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications

Assuntos

RESUMO

Los mielolipomas suprarrenales son neoplasias suprarrenales benignas compuestas como su nombre lo indica, por tejido adiposo y tejido hematopoyético. Comprenden entre 6 - 16% de los incidentalomas suprarrenales, El tamaño de estos tumores es variable, desde unos pocos milímetros hasta > 10 cm, es entonces cuando se denominan adrenomielolipomas gigantes. Los síntomas de presentación más comunes son: Dolor abdominal: 22,5%, dolor en hipocondrio: 13,9%, dolor en el flanco: 13,9%, masa abdominal: 5,2%, y en raras ocasiones, disnea, dolor en espalda, fiebre, pérdida de peso y virilización. Presentación del caso: paciente masculino de 61 años de edad, con presencia de tumor de 15 x 12 cm, dependiente de glándula suprarrenal derecha, que comprime polo superior de riñón derecho, de -20 UH, compatible con mielolipoma suprarrenal derecho gigante, hallazgos incidentales, durante protocolo de estudio por crecimiento prostático, se realiza procedimiento de resección de tumor suprarrenal por abordaje laparoscópico, con excelentes resultados clínicos, sangrado mínimo y recuperación inmediata. Conclusión: el mielolipoma suprarrenal es un tumor benigno que se diagnostica en la mayoría de los casos de manera incidental, se sabe que clínicamente es no funcional, aunque siempre se deben de hacer estudios hormonales preoperatorios. El tratamiento de los mielolipomas suprarrenales, depende de cada caso clínico, siendo una recomendación el tratamiento quirúrgico de los tumores grandes >5 cm, sugerimos que se pueda optar por el abordaje laparoscópico, por ser el menos invasivo y con menor tasa de complicaciones, además de la recuperación pronta del paciente.

Adrenal myelolipomas are benign adrenal neoplasms composed, as the name implies, of adipose tissue and myeloid (hematopoietic) tissue. They comprise between 6 and 16% of adrenal incidentalomas. The size of these tumors is variable and can vary from a few millimeters to more than 10 cm when they are called giant adrenomyelolipomas. The most common clinical presenting symptoms of adrenal myelolipomas are as follows: Abdominal pain: 22.5%, hypochondrial pain: 13.9%, flank pain: 13.9%, abdominal mass: 5.2%, and rarely, dyspnea, back pain, fever, weight loss and virilization. Presentation of the case: 61-year-old male, with the presence of a 15 x 12 cm tumor, dependent on the right adrenal gland, compressing the upper pole of the right kidney, -20 HU, compatible with giant right adrenal myelolipoma, incidental findings, during study protocol due to prostatic growth, a laparoscopic adrenal tumor resection procedure is performed, with excellent clinical results, minimal bleeding and immediate recovery. Conclusion: adrenal myelolipoma is a benign tumor that is diagnosed incidentally in most cases, it is known to be non-functional clinically, although preoperative hormonal studies should always be done. The treatment of adrenal myelolipomas depends on each clinical case, being a recommendation the surgical treatment of large tumors> 5 cm, we suggest that the laparoscopic approach be chosen, as it is the least invasive and with the lowest rate of complications, in addition of the prompt recovery of the patient.

Assuntos

RESUMO

ABSTRACT: Myelolipoma is a benign neoplasm composed of mature adipocytes and hematopoietic elements. This tumor is rare in dogs and cats and can develop in several organs and tissues. This report describes a case of splenic myelolipoma in a dog characterizing its clinical-pathological and ultrasonography aspects. A 9-year-old, female, mixed-breed, castrated dog was referred to the veterinary hospital with increased abdominal circumference. Ultrasonography revealed splenomegaly with masses of not measurable dimensions along the entire length of the parenchyma. The spleen was removed, and a fragment was sent for histopathological analysis. Macroscopically, the spleen was enlarged, with irregularly nodular growths that project above the surface of the organ. Nodules were red with small yellow areas. Microscopically, the spleen was effaced by a well-demarcated and not encapsulated mass composed of histologically well-differentiated neoplastic adipose tissue with islands and nests of varying proportions of hematopoietic elements. Histological examination confirmed the diagnosis of myelolipoma. Myelolipomas are observed on ultrasound images as hyperechoic masses or nodules with homogeneous echo texture. Here, ultrasound appearance involved mixed echogenicity and heterogeneous echotexture, due to the mixture of fat and non-fatty material components of the tumor.

RESUMO: Mielolipoma é uma neoplasia composta por adipócitos maduros e elementos hematopoiéticos. Este tumor é raro em cães e gatos e pode se desenvolver em diversos órgãos e tecidos. Descreve-se um caso de mielolipoma esplênico em um cão caracterizando seu aspecto clínico-patológico e ultrassonográfico. Um canino, fêmea, castrada, SRD, de 9 anos de idade foi encaminhada para o Hospital Veterinário com um aumento na circunferência abdominal. A ultrassonografia abdominal revelou esplenomegalia com massas de dimensões imensuráveis em toda a extensão do parênquima. Foi realizada esplenectomia total e um fragmento do baço foi encaminhado para análise histopatológica. Macroscopicamente o baço estava aumentado de tamanho, com crescimentos nodulares irregulares que se projetam acima da superfície do órgão. Os nódulos eram vermelhos com pequenas áreas amarelas. Microscopicamente foi observada uma massa bem demarcada e encapsulada composta por tecido adiposo neoplásico bem diferenciado, com ilhas e ninhos de elementos hematopoiéticos de proporção variada. O diagnóstico foi confirmado pelo exame histopatológico. Mielolipomas são observados nas imagens ultrassonográficas como massas hiperecóicas ou nódulos com ecotextura homogênea. Neste caso, o achado ultrassonográfico mostrou ecogenicidade mista e ecotextura heterogênea, provavelmente devido à mistura dos componentes do tumor com material gorduroso e não gorduroso.

RESUMO

Myelolipoma is a benign neoplasm composed of mature adipocytes and hematopoietic elements. This tumor is rare in dogs and cats and can develop in several organs and tissues. This report describes a case of splenic myelolipoma in a dog characterizing its clinical-pathological and ultrasonography aspects. A 9-year-old, female, mixed-breed, castrated dog was referred to the veterinary hospital with increased abdominal circumference. Ultrasonography revealed splenomegaly with masses of not measurable dimensions along the entire length of the parenchyma. The spleen was removed, and a fragment was sent for histopathological analysis. Macroscopically, the spleen was enlarged, with irregularly nodular growths that project above the surface of the organ. Nodules were red with small yellow areas. Microscopically, the spleen was effaced by a well-demarcated and not encapsulated mass composed of histologically well-differentiated neoplastic adipose tissue with islands and nests of varying proportions of hematopoietic elements. Histological examination confirmed the diagnosis of myelolipoma. Myelolipomas are observed on ultrasound images as hyperechoic masses or nodules with homogeneous echo texture. Here, ultrasound appearance involved mixed echogenicity and heterogeneous echotexture, due to the mixture of fat and non-fatty material components of the tumor.(AU)

Mielolipoma é uma neoplasia composta por adipócitos maduros e elementos hematopoiéticos. Este tumor é raro em cães e gatos e pode se desenvolver em diversos órgãos e tecidos. Descreve-se um caso de mielolipoma esplênico em um cão caracterizando seu aspecto clínico-patológico e ultrassonográfico. Um canino, fêmea, castrada, SRD, de 9 anos de idade foi encaminhada para o Hospital Veterinário com um aumento na circunferência abdominal. A ultrassonografia abdominal revelou esplenomegalia com massas de dimensões imensuráveis em toda a extensão do parênquima. Foi realizada esplenectomia total e um fragmento do baço foi encaminhado para análise histopatológica. Macroscopicamente o baço estava aumentado de tamanho, com crescimentos nodulares irregulares que se projetam acima da superfície do órgão. Os nódulos eram vermelhos com pequenas áreas amarelas. Microscopicamente foi observada uma massa bem demarcada e encapsulada composta por tecido adiposo neoplásico bem diferenciado, com ilhas e ninhos de elementos hematopoiéticos de proporção variada. O diagnóstico foi confirmado pelo exame histopatológico. Mielolipomas são observados nas imagens ultrassonográficas como massas hiperecóicas ou nódulos com ecotextura homogênea. Neste caso, o achado ultrassonográfico mostrou ecogenicidade mista e ecotextura heterogênea, provavelmente devido à mistura dos componentes do tumor com material gorduroso e não gorduroso.(AU)

Assuntos

RESUMO

El mielolipoma es un tumor benigno de baja incidencia cuya localización más frecuente son las glándulas suprarrenales. Histológicamente se caracteriza por células con precursores mieloides y eritroides mezcladas con tejido adiposo maduro. El diagnóstico en general es incidental en una prueba de imagen. Clínicamente cursa asintomático, aunque los de mayor tamaño tienen más riesgo de complicaciones como sangrado o efecto de masa. Los hallazgos incidentales < 4 cm se deben controlar con imágenes; los > 7 cm, o que generen síntomas, deben ser tratados de forma quirúrgica. Se reporta un caso de mielolipoma extrasuprarrenal en un paciente de 78 años.Myelolipoma is a relatively rare benign tumor which is most commonly located in the adrenal glands. Histologically is characterized by eritroid and myeloid precursor cells intermixed with mature adipose tissue. The diagnosis is generally incidental in abdominal imaging studies. Clinically most are asymptomatic, nevertheless larger tumors are at greater risk for complications such as hemorrhage or compression of surrounding structures. Incidental findings smaller than 4 cm should be followed-up by imaging. Tumors measuring more than 7 cm or those that are symptomatic a surgical approach is mandated. We present the case of a 78-year-old man with an extra-adrenal myelolipoma.

Assuntos

RESUMO

Introducción: Los mielolipomas suprarrenales son tumores benignos inusuales compuestos por tejido adiposo maduro y células hematopoyéticas. Objetivo: Presentar un nuevo caso de mielolipoma suprarrenal y describir sus características clínicas, imaginológicas y la terapéutica aplicada. Caso clínico: Paciente femenina de 68 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus tipo 2 y obesidad mórbida, que ingresó en el Servicio de Cirugía General del Hospital Militar Central Dr. Carlos J. Finlay, por presentar dolor en el hipocondrio derecho. Al examen físico presentaba ligero tinte ictérico de piel y mucosas, dolor abdominal difuso a predominio de hipocondrio derecho, sin reacción peritoneal, signo de Murphy negativo. En el tórax se auscultaron crepitantes bibasales y el murmullo vesicular disminuido. Los exámenes de analítica sanguínea demostraron pruebas hepáticas con valores elevados y eritrosedimentación acelerada. La tomografía axial computarizada abdominal reveló una tumoración, que se correspondía conla glándula suprarrenal derecha, que medía110x135x90 mm. Se realizó la suprarrenalectomía derecha que transcurrió sin complicaciones. El diagnóstico histopatológico fue mielolipoma suprarrenal. La paciente evolucionó satisfactoriamente. Conclusiones: El mielolipoma suprarrenal no presenta un cuadro clínico característico y en muchas ocasiones su hallazgo es incidental. La tomografía axial computarizada es la técnica de elección para el diagnóstico imaginológico de esta lesión. En las masas mayores de 6 cm está indicado el tratamiento quirúrgico, y la cirugía convencional, es un método útil para este fin(AU)

Introduction: Adrenal myelolipomas are unusual slow-growing benign tumors, composed of mature adipose tissue and hematopoietic cells. Objective: To present a new case of adrenal myelolipoma as well as to describe its clinical, imaging and applied therapeutic characteristics. Clinical Case: Female patient of 68 years old, with a history of hypertension, diabetes mellitus type 2 and obese, who was admitted to the General Surgery Service of the Hospital Militar Central Dr. Carlos J. Finlay, for presenting pain in the right hypochondrium. In the general physical examination, she presented a morbid obesity with a slight icteric dye of the skin and mucous membranes, and in the abdomen diffuse abdominal pain was observed, predominantly in the right hypochondrium without peritoneal reaction and negative Murphy sign; no palpated visceromegalias. Bi-basal crackles were heard in the thorax with diminished vesicular murmur. The blood tests performed showed liver tests with high values, and accelerated erythrosedimentation. In the computerized axial tomography an abdominal tumor was observed that impressed to correspond with the right adrenal gland, and that it mediates 110x135x90 mm. The right adrenalectomy was performed without complications. The histopathological diagnosis was an adrenal myelolipoma. The patient has evolved satisfactorily. Conclusions: Adrenal myelolipoma does not present a characteristic clinical picture, so its finding is often incidental. Computed tomography is the technique of choice for the diagnosis of this lesion. In the masses greater than 6 centimeters, surgical treatment is indicated, with conventional surgery being a useful route for this(AU)

Assuntos

RESUMO

Adrenal incidentalomas are tumors located in the adrenal glands and found on imaging done for purposes not related to adrenal disease. In other cases adrenal mases can be radiologically found when an adrenal hormone secreting tumor is suspected, such as a pheochromocytoma or Cushing's diseases. Adrenal incidentalomas may be classified as functional or non-functional based on whether they produce hormones, such as aldosterone, cortisol, and androgens, or catecholamines. Studies indicate that around 8% of adrenal incidentalomas are adrenal gland myelolipomas (AGMs). AGMs are non-malignant masses that can cause the compression of vital organs and vessels if said masses become large enough. In patients with congenital adrenal hyperplasia (CAH), adrenocorticotropic hormone (ACTH) levels tend to be elevated due to the lack of adrenal-hormone production. Patients with CAHs are treated with steroids that suppress ACTH levels and prevent adrenal gland hyperplasia. Around 10% of AGMs are found in untreated CAHs. Our patient was a 36-year-old male who was on steroids due to CAH and intermittent abdominal pain; a CT scan revealed a large left adrenal mass that was displacing organs towards the right. Pathological analysis revealed an AGM exceeding 30 x 23.6 x 16.7 cm. This AGM is one of the largest ever to be reported in the literature.

Assuntos

RESUMO

Ectopic adrenal gland is an atypical medical condition with a prevalence of less than 1%. It occurs due to an abnormal gland development during embryonic life and can be found in different parts of the body. Rarely, these ectopic glands can be hormonally active and present as bulky masses. Herein we report a case of a patient who underwent laparoscopic surgery for a large myelolipoma associated with an androgen producing adenoma in an ectopic adrenal gland.

RESUMO

Myelolipoma is an unusual benign neoplasm in veterinary medicine. This work intended to report the occurrence of hepatic myelolipomas in Neotropical primates of the Callimico goeldii species kept in captivity. These cases were diagnosed during necropsy in a survey on liver neoplasms in the period of 2004 to 2008. Two cases were found in adult male, and two in adult female animals. The diagnoses were obtained through data analysis of necropsy records, pathological examination of the cases, and histological confirmation. Three (75%) of the animals showed clinical signs of progressive weight loss, and two (50%) of them exhibited regional abdominal bloating. The livers had protrusions of pale yellow color on the surface of all lobes. Histologically, the tumors were formed by mature myeloid tissue with high hematopoietic cellularity, represented by the megakaryocytes and meroblastic cells and immature erythroblasts. We conclude that non-human primates of the Callimico goeldii species might have predisposition for liver myelolipoma, which are neoplasms that can lead to the failure and destruction of this organ.

Assuntos

RESUMO

Myelolipoma is an unusual benign neoplasm in veterinary medicine. This work intended to report the occurrence of hepatic myelolipomas in Neotropical primates of the Callimico goeldii species kept in captivity. These cases were diagnosed during necropsy in a survey on liver neoplasms in the period of 2004 to 2008. Two cases were found in adult male, and two in adult female animals. The diagnoses were obtained through data analysis of necropsy records, pathological examination of the cases, and histological confirmation. Three (75%) of the animals showed clinical signs of progressive weight loss, and two (50%) of them exhibited regional abdominal bloating. The livers had protrusions of pale yellow color on the surface of all lobes. Histologically, the tumors were formed by mature myeloid tissue with high hematopoietic cellularity, represented by the megakaryocytes and meroblastic cells and immature erythroblasts. We conclude that non-human primates of the Callimico goeldii species might have predisposition for liver myelolipoma, which are neoplasms that can lead to the failure and destruction of this organ.(AU)

Assuntos

RESUMO

Introducción: Los mielolipomas suprarrenales son tumores benignos e infrecuentes, formados por tejido adiposo y hematopoyético. Se consideran incidentalomas porque se diagnostican fortuitamente en estudios de imagen investigando síntomas abdominales o lumbares o en chequeos rutinarios. Son hormonalmente inactivos casi siempre. Se operan si presentan gran tamaño y usualmente se mantienen estables durante su evolución natural. Objetivos: Identificar las características de los mielolipomas suprarrenales y describir su evolución natural. Métodos: Se realizó un estudio descriptivo retrospectivo en 17 pacientes con mielolipomas suprarrenales diagnosticados por tomografía axial computarizada entre enero de 2006 y abril de 2018. Se estudiaron variables clínicas, hormonales y tomográficas al inicio en 17 pacientes y evolutivamente en 5 pacientes no operados. Se utilizaron medidas de resumen para las variables cualitativas (número y porcentajes) y para las cuantitativas (media y desviación estándar). Resultados: La edad promedio fue 52,9 años y la distribución por sexo: 13 mujeres y 4 hombres (razón 3,2:1). Se indicó tomografía axial computarizada en 11 pacientes por síntomas dolorosos. El tamaño promedio fue 5,6 cm. En 8 tumores el diámetro fue de 6 cm y más. En 9 pacientes se realizó adrenalectomía laparoscópica. Durante la evolución natural, que promedió 5 años y 1 mes, una paciente presentó crecimiento de sus dos masas bilaterales; la derecha se extirpó por sobrepasar los 6 cm. Conclusiones: Los mielolipomas suprarrenales fueron benignos, alcanzaron gran tamaño y provocaron síntomas dolorosos. Fueron hormonalmente inactivos en su mayoría. Evolutivamente, el crecimiento fue muy infrecuente y no hubo transformación maligna ni desarrollo de hiperfunción endocrina(AU)

Introduction: Suprarenal myelolipomas are infrequent benign tumors formed by adipose and hematopoietic tissue. They are considered to be incidentalomas because they are found and diagnosed accidentally in imaging studies intended for abdominal or lumbar problems, or in routine checkups. Suprarenal myelolipomas are almost always hormonally inactive. They are operated on when they are large, and they usually remain stable during their natural evolution. Objectives: Identify the characteristics of suprarenal myelolipomas and describe their natural evolution. Methods: A retrospective descriptive study was conducted of 17 patients with suprarenal myelolipomas diagnosed by computerized axial tomography from January 2006 to April 2018. Clinical, hormonal and tomographic variables were analyzed initially in 17 patients and evolutionarily in 5 non-operated patients. Summary measurements were used for qualitative variables (number and percentages) and for quantitative variables (mean and standard deviation). Results: Mean age was 52.9 years and sex distribution was 13 women and 4 men (ratio of 3.2:1). Computerized axial tomography was indicated for 11 patients with pain symptoms. Average size was 5.6 cm. In 8 tumors the diameter was 6 cm or more. Laparoscopic adrenalectomy was performed on 9 patients. During natural evolution, which averaged 5 years and 1 month, one female patient experienced growth of her two bilateral masses, and the one on the right side was removed for it exceeded 6 cm. Conclusions: The study suprarenal myelolipomas were large, benign and caused pain symptoms. Most were hormonally inactive. In evolutionary terms, growth was very infrequent and there was no malignant transformation or development of endocrine hyperfunction(AU)

Assuntos

RESUMO

Background: Myelolipomas are benign tumors composed of a mixture of fat and hematopoietic tissue similar to the bone marrow. They are rare tumors in humans and dogs, and occur generally in the spleen, liver, spinal canal and in the adrenal glands. When they develop in the adrenal glands they feature non-secretory and endocrinologically inactive characteristics, usually without clinical signs or other dysfunctions. Thus, they are often an incidental finding during necropsy. This paper aims to describe a case of functional adrenal gland myelolipoma and spleen myelolipoma in a female dog with clinical signs and laboratory tests compatible with hyperadrenocorticism.Case: A 12 year-old female dog, undefined breed, was treated at the Hospital Unit for Companion Animals of the Pontifical Catholic University of Paraná (PUCPR), São José dos Pinhais, Paraná, Brazil, with polyuria, polydipsia, polyphagia, cutaneous hypotonia and central obesity. Blood tests showed hypercholesterolemia and increased alkaline phosphatase; urinalysis identified isostenuria with proteinuria; and ultrasound and MRI of the abdomen indicated right adrenomegaly, with heterogeneous characteristics, without invasion of attached blood vessels and splenic nodules. The low dose dexamethasone suppression test was performed which confirmed hyperadrenocorticism. The animal was submitted to adrenalectomy and splenectomy, and tissue specimens were obtained for histopathological examination, which revealed mature adipocytes and hematopoietic elements in different phases of maturation, compatible with adrenal and spleen myelolipoma. After surgical treatment, there was a progressive improvement of the clinical manifestations and laboratory abnormalities of hypercortisolemia, without recurrence during one year.[...]

Assuntos

RESUMO

Background: Myelolipomas are benign tumors composed of a mixture of fat and hematopoietic tissue similar to the bone marrow. They are rare tumors in humans and dogs, and occur generally in the spleen, liver, spinal canal and in the adrenal glands. When they develop in the adrenal glands they feature non-secretory and endocrinologically inactive characteristics, usually without clinical signs or other dysfunctions. Thus, they are often an incidental finding during necropsy. This paper aims to describe a case of functional adrenal gland myelolipoma and spleen myelolipoma in a female dog with clinical signs and laboratory tests compatible with hyperadrenocorticism.Case: A 12 year-old female dog, undefined breed, was treated at the Hospital Unit for Companion Animals of the Pontifical Catholic University of Paraná (PUCPR), São José dos Pinhais, Paraná, Brazil, with polyuria, polydipsia, polyphagia, cutaneous hypotonia and central obesity. Blood tests showed hypercholesterolemia and increased alkaline phosphatase; urinalysis identified isostenuria with proteinuria; and ultrasound and MRI of the abdomen indicated right adrenomegaly, with heterogeneous characteristics, without invasion of attached blood vessels and splenic nodules. The low dose dexamethasone suppression test was performed which confirmed hyperadrenocorticism. The animal was submitted to adrenalectomy and splenectomy, and tissue specimens were obtained for histopathological examination, which revealed mature adipocytes and hematopoietic elements in different phases of maturation, compatible with adrenal and spleen myelolipoma. After surgical treatment, there was a progressive improvement of the clinical manifestations and laboratory abnormalities of hypercortisolemia, without recurrence during one year.[...](AU)

Assuntos