Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, TX, USA.
Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA.
Clin Endocrinol (Oxf). 2020 Jul;93(1):11-18. doi: 10.1111/cen.14188. Epub 2020 Apr 23.
We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery.
A retrospective study.
Consecutive patients with myelolipoma.
A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P < .0001), cause mass effect symptoms (32% vs 0%, P < .0001), have haemorrhagic changes (14% vs 1%, P < .0001) and undergo adrenalectomy (52% vs 5%, P < .0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (-10, 115) and median growth rate was 0 mm/y (-6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P = .02), haemorrhagic changes (12% vs 2%, P = .007) and adrenalectomy (35% vs 8%, P < .0001).
Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.
我们旨在描述骨髓脂肪瘤的临床过程，并确定肿瘤生长和手术需求的预测因素。
回顾性研究。
连续的骨髓脂肪瘤患者。
在 305 名患者中诊断出 321 个骨髓脂肪瘤（中位数大小为 2.3cm），中位年龄为 63 岁（范围为 25-87 岁）。中位随访时间为 54 个月。大多数骨髓脂肪瘤是偶然发现的（86%），而 9%是在癌症分期时发现的，5%是在因肿块效应症状进行检查时发现的。37 例（12%）患者接受了肾上腺切除术。与<6cm 的骨髓脂肪瘤相比，≥6cm 的肿瘤更有可能是双侧的（21%比 3%，P<.0001），引起肿块效应症状（32%比 0%，P<.0001），发生出血性变化（14%比 1%，P<.0001），并接受肾上腺切除术（52%比 5%，P<.0001）。在有≥6 个月影像学随访的患者中，中位大小变化为 0mm（-10，115），中位生长速度为 0mm/y（-6，14）。与<1cm 的生长相比，≥1cm 的生长与更大的初始大小（3.6cm 比 2.3cm，P=.02）、出血性变化（12%比 2%，P=.007）和肾上腺切除术（35%比 8%，P<.0001）相关。
大多数骨髓脂肪瘤是在横断面成像上偶然发现的。≥6cm 的骨髓脂肪瘤更有可能引起肿块效应症状，发生出血性变化并需要切除。肿瘤生长≥1cm 与较大的骨髓脂肪瘤和出血性变化有关。在有症状的大肿瘤患者和有出血或肿瘤生长证据时，应考虑进行肾上腺切除术。
