PMC3985784_01
a CT scan of the abdominal mass seen in transverse view. b MRI scan of the abdominal mass seen in coronal view.
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F1
A minimally enhancing 22 x 16 x 23 cm mass was visualized in the left upper and mid-abdomen displacing the spleen and stomach posterosuperiorly, the pancreas anteriorly and the left kidney inferiorly (fig. 1b). A contrast-enhanced CT scan of the abdomen to further characterize the mass showed no infiltration of the surrounding vasculature or organs, and the left adrenal gland was visualized although it could not be confirmed if the mass was arising from the adrenals (fig. 1a).
a Low-power magnification of the biopsy showing capsule (red arrowhead), adrenal tissue (black arrowhead) and an admixture of adipose and hematopoietic cells. b High-power magnification of the biopsy showing adipocytes (black arrowhead), erythroid precursors (cyan arrowhead), lymphoid precursors (blue arrowhead) and megakaryocytes (green arrowhead). Bony spicules and sinusoids are conspicuously absent from the specimen confirming it is a myelolipoma.
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F2
A needle biopsy of this mass showed adipose tissue with foci of extramedullary hematopoiesis consistent with myelolipoma without any evidence of malignancy, confirming this mass to be a benign myelolipoma (fig. 2a, b).
a Resected specimen showing a well-encapsulated tumor. b Resected specimen cut surface revealing adipose tissue with interspersed areas of hemorrhage.
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F3
During surgery, the mass was found to be soft, highly vascular but well encapsulated and attached only to the left adrenal gland via a small portion that was resected along with the mass (fig. 3a, b).