Learning objectives
To illustrate the CT and MR imaging findings of extra-adrenal myelolipoma.
To describe the role of nuclear medicine in the differential diagnosis of a fatty mass,
particularly liposarcoma.
Background
Myelolipoma is a benign tumor composed of fatty and hematopoietic elements.
Tumors are most frequently localized in the adrenal gland,
followed by the presacral region.
Prognosis is generally excellent,
and most masses do not need surgical intervention.
An accurate diagnosis of fatty masses is mandatory,
since malignant disease such as liposarcoma are included in the differential diagnosis.
Findings and procedure details
Myelolipoma is a mesenchymal tumor that is composed of a mixture of adipose and hematopoietic cells.
This type of tumor is most commonly localized to the adrenal gland; however,
there are rare but well-documented cases of extra-adrenal involvement.
The presacral region is the most frequent extra-adrenal location.
Other reported locations include the pelvic retroperitoneum,
musculofascial tissue,mediastinum,
kidney,
stomach,
and liver.
Extra-adrenal myelolipomas exhibit a slight female predominance and are typically discovered between the ages of 50 to 70 years old.
Most tumors are unilateral and...
Conclusion
Differentiation of presacral myelolipoma from other entities on imaging can be difficult because their imaging features overlap with one another.
The combination of a well-encapsulated fat-containing presacral mass on radiologic studies along with increased uptake on sulfur colloid scintigraphy,
support the diagnosis of a presacral myelolipoma.
References
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Presacral Myelolipoma: Diagnosis on Imaging With Pathologic and Clinical Correlation.
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Bilateral Extraadrenal Perirenal Myelolipomas: An Imaging Challenge.
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Perirenal extra-adrenal myelolipoma.
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