Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2015; 3(9): 853-860
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.853
Two case reports of bilateral adrenal myelolipomas
Yu Yang, Lin-Yang Ye, Bo Yu, Jia-Xiang Guo, Qian Liu, Yun Chen
Yu Yang, Lin-Yang Ye, Bo Yu, Jia-Xiang Guo, Qian Liu, Department of Urology, First Affiliated Hospital of PLA General Hospital, Beijing 100037, China
Yun Chen, BrightstarTech, Inc., Clarksburg, MD 20871, United States
Author contributions: Yang Y, Ye LY, Yu B, and Chen Y conceived and designed the clinical studies; Yang Y, Ye LY, Yu B, Guo JX and Liu Q performed the clinical studies and contributed in management of the patients; Yang Y and Chen Y prepared and revised the paper along with managing the case; Chen Y gave final approval of manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of PLA General Hospital, China.
Informed consent statement: All study participants provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun Chen, MD, PhD, BrightstarTech, Inc., 23102 Meadow Mist Rd, Clarksburg, MD 20871, United States. yun.chen@brightstartechinc.com
Telephone: +1-301-3183442 Fax: +1-301-9443548
Received: March 20, 2015
Peer-review started: March 24, 2015
First decision: May 13, 2015
Revised: May 30, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: September 16, 2015
Abstract

Primary adrenal myelolipoma is a rare, non-functioning adrenal benign tumor that is composed of mature adipose tissue and a variable amount of haemopoietic elements. Clinically, it is difficult to get diagnosed with adrenal myelolipoma because the patient usually doesn’t have obvious symptoms and signs in early stage. In the present study, two cases of primary bilateral adrenal myelolipomas are reported. Clinical presentation, imaging diagnostic features, histopathological changes and surgical treatments of the two patients are discussed. Preoperative diagnostic imaging examinations (B-mode ultrasonography, computed tomography and magnetic resonance imaging sans) assisted getting a prediction diagnosis of bilateral adrenal myelolipomas. A two-stage surgery was used to successfully excise bilateral adrenal myelolipomas in the two patients. Conventional open adrenalectomy was applied to remove the adrenal myelolipomas greater than 6 cm, and laparoscopic adrenalectomy was performed to excise the adrenal tumors smaller than 6 cm. Bilateral adrenal myelolipomas of the two patients were finally confirmed by postoperative histopathological examinations. Understanding clinical, imaging diagnostic and histopathological features of bilateral adrenal myelolipomas will facilitate timely diagnosis and treatment of this condition. Surgical removal of bilateral adrenal myelolipomas is safe, curative and beneficial. The two-stage surgery appears to be the best treatment option for the patients with bilateral adrenal myelolipomas because it achieves optimal treatment effectiveness with minimized sequelae.

Keywords: Bilateral adrenal myelolipomas, Magnetic resonance imaging scan, Imaging diagnosis, B-mode ultrasonography, Computed tomography scan, Two-stage surgery, Histopathological examination

Core tip: Adrenal myelolipoma is a rare adrenal benign tumor. It is not easy to get diagnosed with the tumor due to lack of obvious clinical symptoms and signs in early stage. This report discusses clinical, imaging diagnostic and histopathological features in two patients with bilateral adrenal myelolipomas as well as a two-stage surgical strategy for removal of the adrenal tumors. Understanding clinical, imaging diagnostic and histopathological features of bilateral adrenal myelolipomas will facilitate timely diagnosis and treatment of this condition.