Adrenal myelolipoma with severe hemorrhage: a case report

Adrenal masses are identified with abdominal imaging, most of them are benign and nonfunctioning. They are typically managed conservatively; however, large lesions may present with complications requiring urgent intervention. We present a case of a 65-year-old male with right flank pain found to have a rapidly enlarging hemorrhagic right adrenal mass measuring 15.4 × 13.1 × 17.9 cm with mixed fat and soft tissue components. Hormonal evaluation was negative for a functional adrenal tumor, though malignancy could not be excluded due to ongoing hemorrhage and lesion size. The patient required blood transfusion and open adrenalectomy with en bloc right colectomy. The mass was densely adherent to surrounding structures with significant clot burden. Final pathology confirmed an adrenal myelolipoma composed of mature adipose tissue and tri-lineage hematopoietic elements with extensive intra-tumoral hemorrhage and necrosis. This case highlights the importance of prompt surgical management of large hemorrhagic adrenal masses.