PMC7752288_01
A CT for abdominal pain in November 2012 revealed a presumed adrenal myelolipoma with a focus of macroscopic fat (a). In comparing to a prior exam from April 2007 (b), this mass had grown in size, and subsequent imaging from April 2016 (c) continued to demonstrate growth.
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A1C (HbA1C) = 7.5%), hypertension, and recurrent episodes of cellulitis. A contrast-enhanced CT scan of the abdomen and pelvis in the portal venous phase was obtained that showed no source for her abdominal pain but did note an incidental 5.5 x 4.0 cm left adrenal tumor containing macroscopic fat and reported as a myelolipoma (Figure 1(a)). This tumor had grown from a CT scan in April 2007, where it measured 4.4 x 3.3 cm (Figure 1(b)). A repeat CT showed the tumor had increased in size to 5.8 cm and was still partially composed of macroscopic fat and consistent with a myelolipoma (Figure 1).
The surgical specimen demonstrates the characteristic macroscopic fat component of the myelolipoma with an adjacent well-circumscribed solid golden yellow adenoma.
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On surgical pathology, she was noted to have a 6.7 cm adrenal collision tumor comprised of a 4 cm adrenocortical adenoma and a 2.7 cm myelolipoma (Figure 2).
Patient weight and hemoglobin A1C graphed over time.
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Her weight decreased to 149.4 kg with a BMI of 51.6 and HbA1c of 7.3% (Figure 3).