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CASEREPORTOpenAccessGiantlipomaoftheadrenalgland:acasereportRashmiDPatel1*,ArunaVVanikar1,PranjalRModi2AbstractIntroduction:Lipomaoftheadrenalglandisrarewithareportedincidenceofbetween2%to4%.
Improvedimagingtechniqueshavehelpedinthediagnosisoftheselesions.
Casepresentation:Wereportanincidentallydetectedgiantadrenallipomaina43-year-oldAsianmanwithasixyearhistoryofhypertension.
Hehadamyocardialinfarctiononeyearearlier,forwhichhewastakinganantiplateletagentinadditiontoantihypertensivemedication.
Thetumorwasdetectedbycomputedtomographyandmagneticresonanceimaging,andwasalarge,well-defined,alteredsignalintensitylesion12cminsizeintherightsuprarenalregion.
Thetumorwasresectedlaparoscopicallyandsentforhistopathologicevaluation.
Itmeasured15cm*11.
5cm*6.
5cmongrossexamination,weighed810gandhadahomogenousyellowcutsurface.
Thepostoperativecoursewassmooth.
Microscopyrevealedmatureadiposetissuewithmyxoiddegeneration.
Overthecourseofafourmonthfollow-upthepatientrecovered.
Conclusion:Giantlipomaoftheadrenalgland,abenigntumor,israrecomparedwithmyelolipoma.
Improvedradiologicmodalitieshaveledtoincreasedreportingofthesebenigntumors.
Laparoscopicremovalofthetumorhashelpedinearlyrecoveryandinreinstatingpatientstonormallives.
IntroductionLipomatoustumorsoftheadrenalglandarerare.
Improveddiagnosticmodalities,includinghigh-resolu-tionultrasonography,computedtomography(CT)andmagneticresonanceimaging(MRI),haveledtoincreasedreportingandmanagementofsuchtumors.
Wereportonesuchcaseofanincidentallydetectedadrenallipoma.
CasepresentationA43-year-oldAsianmanwasincidentallydetectedtohavealoose,well-defined,homogenouslyenhancingsofttissuedensitylesionintherightadrenalgland.
Thislesionwasfoundwhilethepatientwasundergoinginvestigationsforhypertensionofsixyears'durationbeingcontrolledwitha-andb-blockersandadiuretic.
Thepatienthadahistoryofmyocardialinfarctionnineearlierforwhichheunderwentcoronaryangioplastyandhewastakinganantiplateletagent.
Duringthisadmission,hehadundergoneultrasonogra-phyoftheabdomen,whichrevealedanadrenalmass.
Noothersignificanthistoryorfindingswerenoted.
Onexamination,thepatient'sbloodpressurewas150/90mmHg.
Achestradiographrevealedprominentvascularmarkingsinbilaterallungfieldswithcardiomegaly.
MRIsuggestedadrenalmyolipomawithalarge,well-defined,alteredsignalintensitylesionintherightsuprarenalregionmeasuring119*105mminsize.
Otherorganswereunre-markable.
Nolymphnodeenlargementwasnoted.
CTscanrevealedalarge,well-defined,softtissuedensitylesionwithintrinsicfatdensityareasintherightadrenalregionmeasuring116*100mminsize(Figure1).
Onlaboratoryinvestigations,thepatient'srandombloodsugarwas82.
6mg/dLandhisrenalandliverfunctionsandelectrolyteswerewithinnormalrange.
Thepatient'shemoglobinwas10.
6g/dL,andcountswerewithinnormalrangeandwerenonreactivetoHIV,hepatitisBsurfaceantigenandhepati-tisCvirusonenzyme-linkedimmunosorbentassay.
Urineanalysisandmicroscopicfindingswereunremarkable.
His24-hoururinaryvanillylmandelicacidlevelwas4.
7mg(referencerange,2-8mg/24h).
Thepatientwassubjectedtotransperitoneallaparoscopicadrenalectomy.
Ongrossexamination,awell-encapsulatedtumormassweighing810gmeasured15*11.
5*6.
5cminsize(Figure2A).
*Correspondence:rashmi381@yahoo.
co.
in1DepartmentofPathology,LaboratoryMedicine,TransfusionServicesandImmunohematology,G.
R.
DoshiandK.
M.
MehtaInstituteofKidneyDiseasesandResearchCentreandDr.
H.
L.
TrivediInstituteofTransplantationSciences,Ahmedabad,IndiaFulllistofauthorinformationisavailableattheendofthearticlePateletal.
JournalofMedicalCaseReports2011,5:78http://www.
jmedicalcasereports.
com/content/5/1/78JOURNALOFMEDICALCASEREPORTS2011Pateletal;licenseeBioMedCentralLtd.
ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.
org/licenses/by/2.
0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Theexternalsurfacewassmoothandgrey-yellowcolored,andtheadjacentadrenalglandmeasuring6*1.
5*0.
5cminsizewasunremarkable.
Thecutsurfacewashomoge-nous,yellowandfattywithmyxomatousareasorajelly-likeappearanceandsofttofirminconsistency.
Microscopyrevealedawell-encapsulatedtumorcomposedofmatureadiposetissuewithmyxoiddegenerativechangesandnor-maladrenalparenchyma(Figure2B).
Thepatienthadanuneventfulpostoperativecourseandisstablewiththesamemedicationscontinuedforonemonth.
Thepatientisnowtakingabeta-blockerandantiplateletagents,andhehasstoppedtakingthealpha-blockeranddiureticthatheneededpreviouslyforbloodpressurecontrol.
DiscussionAdrenallipomasarebenigntumorswithareportedinci-denceof2%to4%ofalladrenaltumors[1-4].
Thedifferentialdiagnosesincludemyelolipoma,angiomyoli-poma,liposarcomaandteratoma.
Thehistogenesisofthesemesenchymaltumorsisstilllittleunderstood.
Lipo-masareknowntooccurontherightsidewithmalepre-dominanceasopposedtomyelolipomas,whichhavenogenderorsitepredilection.
Thesizeofthesetumorsisusuallysmallerthan4cm;however,thetermgiantlipomaispreferredwhenthesizeexceeds8cm.
Ourpatienthadatumorofmorethan11cmindiameter,thusfallinginthecategoryof"giantadrenallipoma.
"Nocalcificationwasnoteddespitethelipoma'slargesize.
ConclusionGiantadrenallipomasarerarebutarebeingreportedmorefrequentlybecauseofimprovedmodernimagingtechnologies.
Thistumorwasremovedwiththerarelyreportedtechniqueoftransperitoneallaparoscopicadre-nalectomyandwasconfirmedhistologically.
ConsentWritteninformedconsentwasobtainedfromthepatientforpublicationofthiscasereportandaccompanyingimages.
AcopyofthewrittenconsentisavailableforreviewbytheEditor-in-Chiefofthisjournal.
Authordetails1DepartmentofPathology,LaboratoryMedicine,TransfusionServicesandImmunohematology,G.
R.
DoshiandK.
M.
MehtaInstituteofKidneyDiseasesandResearchCentreandDr.
H.
L.
TrivediInstituteofTransplantationSciences,Ahmedabad,India.
2DepartmentofUrologyandTransplantation,G.
R.
DoshiandK.
M.
MehtaInstituteofKidneyDiseasesandResearchCentreandDr.
H.
L.
TrivediInstituteofTransplantationSciences,Ahmedabad,India.
Authors'contributionsRDPwasthemajorcontributorinwritingthemanuscriptandanalysisandinterpretationofpatientdataregardingthehistopathologicdisease.
AVVperformedthehistologicexaminationandhelpedinpreparationofthefinalmanuscript.
PRMdidthetransperitoneallaparoscopicadrenalectomyandpostoperativefollow-upofthepatient.
Allauthorsreadandapprovedthefinalmanuscript.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
Received:21October2009Accepted:24February2011Published:24February2011References1.
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doi:10.
1186/1752-1947-5-78Citethisarticleas:Pateletal.
:Giantlipomaoftheadrenalgland:acasereport.
JournalofMedicalCaseReports20115:78.
Figure1Computedtomographyscanshowingalarge,well-defined,softtissuedensitymassintherightsuprarenalregion(bidirectionalarrow).
Figure2A)Cutsurfaceofthegiantadrenallipomawithgoldenyellow-tancolorwithanarrowshowingtheuninvolvedadrenalgland.
B)Photomicrograph(hematoxylinandeosinstain)showingthetumormadeupofmatureadiposetissueintermingledwithnormaladrenalcorticalparenchyma.
Pateletal.
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