2000, Number 3
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ABSTRACTObjective: To report on two patients with adrenal myelolipoma.
Design: Description of cases.
Setting: Third health care level hospital.
Description of patients: We studied all the myelolipoma cases found at the Central Military Hospital until 1998. We found two patients, one diagnosed by means of a preoperative computer-assisted axial tomography (CAAT) and confirmed by histopathological analysis of the surgical sample. This patient presented clinical symptoms, coursing with abdominal pain and palpable mass, associated to obesity, hypertension, diabetes, colonic diverticuli, and biliary lithiasis. Trans-abdominal open surgery was performed. The second patient presented a pulmonary carcinoid tumor that was resected. A year later, through a CAAT, an adrenal mass of 12 cm was detected and another one in the liver. Abdominal laparotomy was performed and the pathological study revealed an adrenal myelolipoma and a ganglioneuroma.
Conclusion: Besides hematopoietic and fatty components, the myelolipoma can present bony elements and coexist with adrenal ganglioneuroma. Its detection remains incidental. Surgical or expectant treatment must be individualized for each patient, but surgery should be considered in the following cases: 1) a larger than 10 cm myelolipoma, 2) of any size but complicated, 3) when the histopathological diagnosis could not be confirmed by fine needle puncture, 4) when expectant management is not possible, and 5) when the patients desires the surgery.
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