Cochetti Giovanni, Paladini Alessio, Boni Andrea, Silvi Elisa, Tiezzi Alberto, De Vermandois Jacopo Adolfo Rossi, Mearini Ettore
Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy.
Mol Clin Oncol. 2019 May;10(5):492-496. doi: 10.3892/mco.2019.1823. Epub 2019 Mar 12.
Adrenal myelolipoma is a rare mesenchymal tumour with benign biological behaviour that is mainly composed of mature adipose and myeloid tissue. Both sexes are equally affected, most commonly between the fifth and seventh decades of life. The diagnosis of adrenal myelolipoma is mostly incidental. Although it may occasionally be associated with necrosis, rupture and haemorrhage, causing abdominal pain, this tumour is usually asymptomatic. Consequently, management is conservative, while surgical treatment is reserved for symptomatic cases, or for masses growing quickly or to a size >6 cm. Giant myelolipomas (sized >10 cm) are rare. Open radical adrenalectomy is the standard treatment for giant myelolipomas, while the minimally invasive approach has been used in only few cases. We herein report the case of a patient with a giant adrenal myelolipoma who underwent robotic partial adrenalectomy. To the best of our knowledge, this is the largest giant adrenal myelolipoma treated with robotic surgery reported in the literature to date. A 55-year-old male patient underwent an abdominal computed tomography scan during follow-up after radical prostatectomy for prostate cancer Gleason Score 6 (ISUP 1) due to biochemical recurrence. The examination revealed a right hypodense adrenal mass, sized 16×13 cm. Abdominal magnetic resonance imaging confirmed the presence of characteristics suggestive of a myelolipoma. The patient did not report any symptoms. Due to the benign characteristics of the mass, robotic partial adrenalectomy and enucleation of the mass were performed. The operative time and estimated blood loss were 205 min and 100 ml, respectively. No intra- or postoperative complications occurred. The patient was mobilized on the first postoperative day and the time to flatus was 36 h; the length of hospitalization was 4 days. Histological examination confirmed the diagnosis of adrenal myelolipoma, sized 18×11.5×6 cm. No tumour recurrence occurred over a follow-up period of 12 months. In conclusion, robotic surgery allows performing partial adrenalectomy with a lower risk of bleeding and with preservation of healthy adrenal tissue, which is of paramount importance for the patient as it reduces recovery time and the need for medical substitution therapy.
肾上腺髓质脂肪瘤是一种罕见的间叶组织肿瘤，具有良性生物学行为，主要由成熟的脂肪组织和髓样组织组成。男女发病率相同，最常见于50至70岁之间。肾上腺髓质脂肪瘤的诊断大多是偶然发现的。虽然它偶尔可能与坏死、破裂和出血有关，导致腹痛，但这种肿瘤通常无症状。因此，治疗以保守为主，手术治疗仅适用于有症状的病例，或肿块生长迅速或直径>6 cm的情况。巨大髓质脂肪瘤（直径>10 cm）很少见。开放性根治性肾上腺切除术是巨大髓质脂肪瘤的标准治疗方法，而微创方法仅在少数病例中使用。我们在此报告一例巨大肾上腺髓质脂肪瘤患者接受机器人辅助部分肾上腺切除术的病例。据我们所知，这是迄今为止文献报道的接受机器人手术治疗的最大的巨大肾上腺髓质脂肪瘤。一名55岁男性患者因前列腺癌Gleason评分6（ISUP 1）行根治性前列腺切除术后随访期间进行了腹部计算机断层扫描。检查发现右肾上腺低密度肿块，大小为16×13 cm。腹部磁共振成像证实存在提示髓质脂肪瘤的特征。患者未报告任何症状。由于肿块具有良性特征，遂行机器人辅助部分肾上腺切除术及肿块剜除术。手术时间和估计失血量分别为205分钟和100毫升。术中及术后均未发生并发症。患者术后第一天即可活动，排气时间为36小时；住院时间为4天。组织学检查证实为肾上腺髓质脂肪瘤，大小为18×11.5×6 cm。随访12个月未发生肿瘤复发。总之，机器人手术能够进行部分肾上腺切除术，出血风险较低，并能保留健康的肾上腺组织，这对患者至关重要，因为它减少了恢复时间和药物替代治疗的需求。
