Question:

Adrenal myelolipomas:
1. Commonly require percutaneous biopsy for diagnosis.
2. Are diagnosed by imaging, either MRI or CT, with confidence.
3. Are less common than extra-adrenal myelolipomas.
4. All of the above.
5. None of the above.





Answer:

The correct answer for the question "Adrenal myelolipomas:" is:

2. Are diagnosed by imaging, either MRI or CT, with confidence.



Explanation

Typical adrenal myelolipomas, containing macroscopic fat, are diagnosed by either CT, or MRI using fat saturation sequences; therefore most often no further investigation is needed. Extra-adrenal myelolipomas are extremely rare. This makes only b. the correct answer. (On imaging, the diagnosis of a myelolipoma can be made with confidence when macroscopic fat is identified within an adrenal mass (3). Only about 50 cases of extra-adrenal myelolipomas are reported in the literature (1)). a., c., d., and e. are wrong.



From the manuscript:
Multifocal extra-adrenal myelolipoma arising in the greater omentum
Radiology Case. 2009 Nov; 3(11):20-23


This article belongs to the GI section.




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From the manuscript

Multifocal extra-adrenal myelolipoma arising in the greater omentum

Free full text article: Multifocal extra-adrenal myelolipoma arising in the greater omentum

Abstract
Myelolipomas are rare benign tumors composed of mature fat and hematopoietic elements. They are most often discovered incidentally within the adrenal glands, with extra-adrenal myelolipomas being extremely rare tumors. We report a case of multifocal omental extra-adrenal myelolipoma in a patient who had undergone bilateral adrenalectomy. To our knowledge, this is the first reported case of an intraperitoneal extra-adrenal myelolipoma.






References



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2. Zieker D, Königstrainer I, Miller S, Vogel U, Sotlar K, Steurer W, Königstrainer A, Lehmann TG. Simultaneous adrenal and extra-adrenal myelolipoma - an uncommon incident: case report and review of the literature. World J Surg Oncol 2008; 6:72.
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3. Marks JB, Casillas J, Levis S. Case report: adrenal myelolipoma-rationale for a noninvasive diagnosis. Am J Med Sci 1992; 303:255-7.
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4. Lamont JP, Lieberman ZH, Stephens JS. Giant adrenal myelolipoma. Am Surg 2002; 68:392-4.
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6. Bishop E. Adrenal myelolipomas show nonrandom X-chromosome inactivation in hematopoietic elements and fat: support for a clonal origin of myelolipomas. Am J Surg Pathol 2006; 30:838-43.
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7. Talwalkar SS, Shaheen SP. Extra-adrenal myelolipoma in the renal hilum: a case report and review of the literature. Arch Pathol Lab Med 2006; 130:1049-52
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8. Minamiya Y, Abo S, Kitamura M, Izumi K. Mediastinal Extraadrenal Myelolipoma: Report of a Case. Jpn J Surg 1997; 27:971-2
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10. Omdal DG, Baird DE, Burton BS, Goodhue WW, Giddens EM. Myelolipoma of the thoracic spine. Am J Neuroradiol 1997; 18:977-9.
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