Laparoscopic excision of a giant adrenal myelolipoma and review of the literature

Abstract

Introduction: Adrenal myelolipoma is a rare benign tumor. It is usually asymptomatic with variable sizes, where the small lesions are usually managed conservatively and the large and symptomatic ones indicate open or laparoscopic adrenalectomy.

Observation: A 45-year-old obese male patient presented with an accidentally-discovered right adrenal mass during abdominal sonographic examination. The mass was clinically-palpable in the right lumbar region. Abdominal computed tomography described a well-circumscribed lesion displacing the right kidney downwards with compression and displacement of the inferior vena cava. It was heterogeneous with 16 cm × 14 cm × 8 cm dimensions and low attenuation appearance. Adrenal myelolipoma was suspected and the patient was counseled for the laparoscopic approach with high possibilities of conversion to open surgery. Laparoscopic excision was done by expert surgeons with demanding dissection from the surroundings, especially the liver and inferior vena cava, but, the mass was successfully removed. The postoperative course was short and uneventful. Histopathological examination confirmed the diagnosis of adrenal myelolipoma.

Conclusions: Laparoscopic excision of giant adrenal myelolipoma is a challenging procedure, but it seems to be a feasible promising approach. Expert surgeons are recommended when operating large tumors, especially, in the obese patients.

Keywords: Adrenal tumor; Laparoscopic adrenalectomy; Myelolipoma