Rare adrenal myelolipoma laparoscopic resection

Abstract

A 48-year-old man presented with three days of severe lower back pain and vomiting. Ultrasonography (US) of abdomen showed a hyper echoic curved lesion with regular edge localized in right suprarenal region measuring 9 × 6 cm. Contrast enhanced computed tomography (CT) of abdomen confirmed that the lesion has pressed the liver obliterating the cleavage adipose locoregional. The lesion was inhomogeneous hypodense with branches blurred. The finding was first suggestive of pheochromocytoma. Opposite adrenal gland and kidney were normal. The complete hemogram, blood biochemistry, serum hormonal profile (TSH, S-17 Idrossiprogesteron, DHEA, Testosterone, Delta-4 Androstenedione, basal cortisol, renin) and hormonal level in urine (Cortisol, Cortisol in 24 h, Aldosterone, Metanefrine, Normetanefrine, vanillylmandelic acid) were normal and confirmed the suspect of AM. Laparoscopic adrenalectomy (LA) was performed with transperitoneal approach. This technique offers a good visualization of operative field reducing intraoperative injuries. The mass was surgically removed and then histopathology analysis was performed. Gross examination showed a lesion of 11 × 9 × 3 cm which looked a curved yellow gray colored mass well capsulated. Histhology showed a proliferation of fat cells interposed isles of erythroid tissue. These features confirmed AM diagnosis.