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Imaging and pathologic features of myelolipoma
P Rao1, P J Kenney, B J Wagner
1Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Summary
Myelolipoma, a benign tumor of fat and bone marrow elements, presents in distinct patterns. Imaging characteristics can help diagnose myelolipoma, but biopsy may be needed for extraadrenal cases.
Area of Science:
- Radiology
- Pathology
- Oncology
Background:
- Myelolipoma is a rare, benign tumor composed of mature adipose tissue and hematopoietic elements.
- It can occur in the adrenal glands or at extraadrenal sites.
- Understanding its diverse presentations is crucial for accurate diagnosis.
Purpose of the Study:
- To correlate imaging findings of myelolipoma with its pathologic and histologic features.
- To describe the clinicopathologic patterns of myelolipoma.
- To evaluate the diagnostic utility of various imaging modalities.
Main Methods:
- Retrospective review of imaging findings in pathologically proven myelolipoma cases.
- Correlation of imaging features with gross and microscopic pathology.
- Analysis of four distinct clinicopathologic patterns: isolated adrenal, adrenal with hemorrhage, extraadrenal, and associated with other adrenal disease.
Main Results:
- Plain radiography is limited unless the lesion is large and fatty.
- Ultrasound shows heterogeneous echogenicity due to nonuniform architecture.
- CT demonstrates fat with interspersed higher-attenuation tissue; MRI shows signal intensity changes.
- Hemorrhage alters imaging appearance, with CT being most accurate for evaluation.
- Pericardial effusion is a rare but serious complication.
Conclusions:
- Imaging characteristics of myelolipoma usually allow presumptive diagnosis.
- Percutaneous needle biopsy may be necessary for extraadrenal myelolipoma confirmation.
- Surgical excision is reserved for unclear diagnoses or symptomatic lesions; asymptomatic, nonhemorrhagic cases require no therapy.