PMC4485682_01
CT scan.
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A CT (Fig. 1) highlighted a huge right adrenal mass sized about 17 x 12 cm (-20HU) and a similar lesion of 2.3 x 2.5 cm (-5HU) in the left adrenal gland.
MRI.
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MRI (Fig. 2) confirmed the presence of bilateral adrenal mass containing mainly fat with multiple septa, both consistent with myelolipomas.
Resected specimen.
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In order to remove the huge symptomatic lesion, we performed a right open adrenalectomy (Fig. 3), using a Chevron incision. Macroscopically (Fig. 3), the specimen was a capsulated nodular lesion of 17 cm in diameter, weighing 1.170 kg.
Intraoperative picture showing the tumor bed after removal of the right myelolipoma. a: diaphragm, b: hepatic flexure, c: Gerota's fascia, d: inferior vena cava, e: right liver completely mobilized.
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In order to safely and easily remove the main adrenal lesion (especially to achieve an adequate control of the adrenal vein), the Kocher maneuver have been required, together with the complete mobilization of the right liver and the right colic flexure, mainly because the mass being adherent to the right aspect and rear of the inferior vena cava (Fig. 4).
Microscopical image.
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Microscopically (Fig. 5), the specimen showed a well-defined margins tumor, partly bounded by thin connective tissue capsule, largely consisting of mature adipose tissue with extensive hemosiderosis.