[Giant myelolipoma of the adrenal gland]

Myelolipoma is a rare benign tumor of adrenal gland, composed from a fatty tissue and hematogenous elements. It may be associated with endocrine disorders such as androgyneity, Cushing's disease, Addison's disease and other causes including obesity. It may also occur as a soft-tissue mass in various regions, especially in the area of small pelvis. Giant myelolipomas of adrenal gland have rarely been described in the world literature and it was considered useful to describe this case.

A 54-year woman was examined in an internal ward for arterial hypertension and an ultrasound abdominal examination was therefore indicated. The finding was later confirmed by CT examination, which demonstrated a sizable expansion with fatty densities and a stroma, which was slightly more visible after the administration of a contrast compound, projecting in the region of the right adrenal gland.

The formation is most probably a myelolipoma. No disease-related symptoms were detected. A surgical extirpation of three tumors of the same character was made. The diameter of the largest tumor was at least 140 mm. The diagnosis of myelolipoma was confirmed by histological examination. The patient was cured up and released from the hospital on day 12 after the operation.

The tumor is without symptoms in most cases, but bleeding or rupture may occur. It is rarely associated with endocrine disorders. Etiology is so far not clear. The diagnosis can be established by US, CT or MR examination. The operation is indicated in patients with symptoms, tumor of large size, in case of bleeding etc. Small tumors may be followed subsequently. The surgical intervention, extirpation of the tumor, may also be done by laparoscopy. This paper appears to be the first published information about myelolipoma of adrenal grand, especially of such considerable size, in the Czech medical literature.