Steka Xanthi, Martens Florian, Renzulli Mariko Melanie, Hauswirth Fabian, Vrugt Bart, Renzulli Pietro
Department of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Institute of Radiology, Cantonal Hospital Thurgau, Frauenfeld, Switzerland.
Int J Surg Case Rep. 2022 Sep;98:107527. doi: 10.1016/j.ijscr.2022.107527. Epub 2022 Aug 17.
Adrenal myelolipomas (AMLs) are rare, non-functional, benign tumours mostly diagnosed incidentally. They present as small and unilateral masses that are histologically composed of mature adipose tissue with admixed haemopoietic elements. In a small percentage of patients, pressure symptoms, retroperitoneal haemorrhage or tumour rupture may occur. However, indications for surgery in the majority of asymptomatic patients are poorly defined.
A 44-year old male patient presented with signs of gastroenteritis. Computed tomography (CT) imaging revealed an encapsulated, sharply delineated mass measuring 87 × 76 × 87 mm displacing the right adrenal gland. Average attenuation was -30 Hounsfield units. Given the pathognomonic features, an AML was suspected. The patient underwent open tumour resection and the diagnosis was histologically confirmed.
Small (<4 cm), homogeneous, non-hormone secreting incidentalomas with an attenuation of <10 Hounsfield units on non-contrast CT are considered benign requiring neither treatment nor follow-up. Giant AMLs (>10 cm) may cause symptoms or complications and are therefore considered candidates for surgery. The treatment strategy of asymptomatic AMLs ranging from 4 cm to 10 cm, however, is controversial and poorly defined. The role of surgery in this specific subgroup of patients is studied.
Surgery is indicated in the presence of a tumour diameter above 6 cm, rapid tumour growth (RECIST 1.1 criteria for progressive disease at 6-12 months follow-up), imaging suspicious of malignancy, radiological signs of local invasion, functioning ipsilateral adrenocortical adenoma, pressure-related symptoms and signs of retroperitoneal bleeding or spontaneous tumour rupture.
肾上腺髓脂肪瘤（AML）是一种罕见的、无功能的良性肿瘤，大多为偶然发现。它们表现为单侧小肿块，组织学上由成熟脂肪组织和造血成分混合组成。少数患者可能出现压迫症状、腹膜后出血或肿瘤破裂。然而，大多数无症状患者的手术指征尚不明确。
一名44岁男性患者出现肠胃炎症状。计算机断层扫描（CT）成像显示一个边界清晰、包膜完整的肿块，大小为87×76×87mm，推移了右肾上腺。平均衰减值为-30亨氏单位。鉴于其典型特征，怀疑为AML。患者接受了开放性肿瘤切除术，组织学检查确诊。
非增强CT上衰减值<10亨氏单位的小（<4cm）、均匀、不分泌激素的偶然发现瘤被认为是良性的，无需治疗或随访。巨大AML（>10cm）可能引起症状或并发症，因此被视为手术候选者。然而，直径在4cm至10cm之间的无症状AML的治疗策略存在争议且尚不明确。本研究探讨了手术在这一特定亚组患者中的作用。
当肿瘤直径大于6cm、肿瘤快速生长（根据RECIST 1.1标准，随访6至12个月时疾病进展）、影像学怀疑为恶性、有局部侵犯的放射学征象、同侧肾上腺皮质腺瘤有功能、有压迫相关症状以及腹膜后出血或肿瘤自发破裂的征象时，建议进行手术。
