Alkhalifa Abdullah Mahmoud, Aldossary Mohammed Yousef, Abusultan Ammar Jamal, AlQattan Abdullah Saleh, Alsomali Mohammed, Alquraish Fatimah, Alkhaldi Njoud, Alsaeed Jamal Y, Alwosaibei Abdulaziz M, Alqambar Mohammed, Alsaif Osama Habib
Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Al-Khobar, Dammam 31441, Saudi Arabia.
Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
Int J Surg Case Rep. 2020;67:54-61. doi: 10.1016/j.ijscr.2020.01.027. Epub 2020 Jan 26.
Lipomatous tumors of the adrenal glands are a diverse group of tumors characterized by the composition of adipose tissue. This group of tumors include myelolipomas, angiomyolipomas (AML), lipomas, and teratomas. They are usually benign, non-functioning tumors, and they account for 5% of all primary adrenal tumors. This study aimed to elucidate the management of the initial size of the adrenal mass and symptoms of presentation. We provide a succinct literature review regarding angiomyolipomas tumors of the adrenal glands.
Here, we report 5 cases of lipomatous tumors of the adrenal glands. All 5 tumors were non-functioning. Four of them were myelolipoma, and one was AML. Two cases of myelolipoma presented with flank pain, while the rest of the 3 cases presented with hypochondrium pain. Three cases of myelolipoma were managed with laparoscopic adrenalectomy, one case of myelolipoma was converted from laparoscopic to open adrenalectomy because of abdominal adhesions, and the last case was AML and was managed with open adrenalectomy. All patients had an uneventful recovery with regular follow-up.
Myelolipoma, the most common lipomatous tumor of the adrenal gland, consists of a mixture of bone morrow element and adipose tissue. AML consists of a mixture of a thick-walled blood vessel, smooth muscle, and adipose tissue. They mimic many different benign and malignant tumors on radiography, and the histopathological examination is still needed to confirm the diagnosis. There is still controversy in the management of these tumors. Usually, the management is individualized on each case. Reporting of these tumors are increasing due the wide-spread use of modern imaging modalities.
Adrenal lipomatous tumors are uncommon but with the increase use of imaging modalities their detection has increased. Further studies are needed to establish guidelines in the management of these tumors, especially that they can mimic malignant conditions.
肾上腺脂肪性肿瘤是一组以脂肪组织成分为特征的多样化肿瘤。这类肿瘤包括髓脂肪瘤、血管平滑肌脂肪瘤（AML）、脂肪瘤和畸胎瘤。它们通常是良性的、无功能的肿瘤，占所有原发性肾上腺肿瘤的5%。本研究旨在阐明肾上腺肿块初始大小的处理及临床表现。我们提供了一篇关于肾上腺血管平滑肌脂肪瘤的简要文献综述。
在此，我们报告5例肾上腺脂肪性肿瘤。所有5个肿瘤均无功能。其中4例为髓脂肪瘤，1例为AML。2例髓脂肪瘤表现为侧腹痛，其余3例表现为季肋部疼痛。3例髓脂肪瘤采用腹腔镜肾上腺切除术治疗，1例髓脂肪瘤因腹部粘连由腹腔镜肾上腺切除术转为开放性肾上腺切除术，最后1例为AML，采用开放性肾上腺切除术治疗。所有患者经定期随访均恢复良好。
髓脂肪瘤是肾上腺最常见的脂肪性肿瘤，由骨髓成分和脂肪组织混合而成。AML由厚壁血管、平滑肌和脂肪组织混合而成。它们在影像学上可模仿许多不同的良性和恶性肿瘤，仍需组织病理学检查来确诊。这些肿瘤的治疗仍存在争议。通常，对每个病例的治疗都是个体化的。由于现代成像方式的广泛应用，这些肿瘤的报告数量在增加。
肾上腺脂肪性肿瘤并不常见，但随着成像方式使用的增加，其检出率有所提高。需要进一步研究以建立这些肿瘤的治疗指南，特别是因为它们可能模仿恶性疾病。
