PMC5946595_01
Presacral myelolipoma: (a) CT images show a presacral mass at S3-S5:top and middle, soft-tissue windows (width = 250, center = 30); bottom, bone windows (width = 2000, center = 400). The tumor has lobulated contours and a heterogeneous appearance, containing low CT values (-20 to -40 HU) suggesting fat tissue. MRI shows a lobulated lesion with heterogeneous low to high signal intensity on T1-weighted (top) and T2-weighted (middle) images. The degree of suppression on T2-weighted fat-suppression images is low but visible (bottom) ((b) sagittal, (c) axial).
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No destruction of the adjacent sacral vertebra was seen (Figure 1(a)). On magnetic resonance imaging (MRI), the lesion appeared to be heterogeneous with intermediate to high signal intensity on T1- and T2-weighted images and was lobulated by septae with low signal intensity on T1-weighted images (Figure 1(b) and (c)). A low degree of suppression at high signal intensity on T2-weighted fat-suppression images was observed (Figure 1(b) and (c)).
Presacral myelolipoma. Histopathologic analysis shows predominantly mature adipose tissue intermixed with extramedullary hematopoietic components (H & E staining; original magnification; left x20, right x40). There is no intra-tumoral hemorrhage.
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The diagnosis was extra-adrenal myelolipoma, or presacral myelolipoma, because there was no chance of bone marrow tissue contamination in the specimen (Figure 2).