A rare case of co-existing adrenal and pelvic myelolipomas

We are reporting a case of co-existing left sided pelvic and right sided adrenal myelolipomas in a 68-year-old male patient. Both lesions were incidentally discovered on CT whilst undergoing a staging scan for suspected urinary bladder cancer. The patient had a background of hypertension and type 2 diabetes. Contrast enhanced CT scan showed both lesions to be of mixed fat and soft tissue density. Given the size, location, and attenuation characteristics of the pelvic mass, retroperitoneal liposarcoma was thought to be a differential diagnosis, prompting the decision for an elective CT-guided biopsy. Both masses were targeted successfully using core biopsy needles. Subsequently, histopathology results for both the right adrenal and the left pelvic masses showed features compatible with myelolipomas. The right retroperitoneal mass was compatible with an adrenal myelolipoma and left pelvic mass was deemed as an extra-adrenal myelolipoma (EAML).