Laparoscopic resection of giant myelolipoma on the right adrenal gland
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Hellenic Journal of Surgery (2016) 88:5, 356-359
Laparoscopic Resection of Giant Myelolipoma on the Right Adrenal Gland Naveen Kumar, Neeti Kapur
Abstract Aim-Background: Adrenal myelolipoma is a rare hormonally inactive benign neoplasm arising from the adrenal
cortex. Traditionally, laparoscopic removal of an adrenal tumour > 5-6 cm in size is contraindicated. In the case presented herein, a 15 cm myelolipoma by was removed by laparoscopy. The aim of the present presentation is to show that the laparoscopic resection of a giant benign adrenal tumour larger than 6 cm in size is feasible. Case: This report pertains to a giant adrenal myelolipoma in a 25-year-old housewife complaining of mild pain in
the right hypochondrium and lumbar region for the last six years. Abdominal examination revealed a well-defined, large mass in the right lumbar region. CECT of abdomen showed typical features of myelolipoma of the right adrenal gland. She was submitted to laparoscopic surgery and the right adrenal mass measuring 15cm x 13cm was removed. Histopathology of the tumour confirmed adrenal myelolipoma. Results: Surgical resection is considered in cases of a large and symptomatic mass. Recent studies have shown that the laparoscopic approach in these patients is technically feasible, safe and comparable with the open approach. Conclusion: Adrenal myelolipoma is a rare condition, usually diagnosed as incidentaloma and followed with CT
and MRI. Surgery is recommended only for those patients who are symptomatic and present with a large tumour. The laparoscopic approach in these patients is technically feasible, safe and comparable with the open approach. Key words: Giant myelolipoma; adrenal gland; surgical resection; laparoscopic approach
Introduction
Presentation
Adrenal myelolipoma is a rare, hormonally inactive benign neoplasm arising from the adrenal cortex and is composed of mature adipose tissue and a variable amount of normal haematopoietic elements [1,2]. The tumour was first discovered by Gierke in 1905 [10]. Most lesions are small and asymptomatic [3,4], while others may present with non-specific complaints, such as abdominal or flank pain or as an abdominal mass. In cases of a large and symptomatic mass with areas of haemorrhage, necrosis, or suspicion of malignancy, surgical resection has to be considered. Traditionally, laparoscopic removal of an adrenal tumour greater than 5-6 cm in size is contraindicated [9]. In the case presented herein, an 11 cm myelolipoma was removed by laparoscopy without any complications.
A 25-yr-old female housewife was admitted with a 6-year history of mild pain in the abdomen in the right hypochondrium and lumbar region, and a 4-year history of burning micturition and irregular menstrual cycle. The patient had no other complaints. On examination, her pulse rate was 84/min, and BP was 124/68mmhg. On general examination, no abnormality was found. Physical examination of the abdomen revealed a firm, non-tender, bimanually palpable mass (40x40) with well-defined margins in the right
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