Rare huge bilateral adrenal myelolipoma confused with retroperitoneal liposarcoma

Introduction

Adrenal myelolipomas are uncommon benign adrenal tumors, which mostly occur unilaterally. We describe a rare case of giant bilateral adrenal myelolipoma mistaken for retroperitoneal liposarcoma.

Case presentation

A 49-year-old man developed fever, left flank pain, and a large mass in his left abdomen. Plain computed tomography showed a 23-cm mass with fat-containing components in the retroperitoneal cavity, suggestive of retroperitoneal liposarcoma. A similar 9-cm mass was observed in the right adrenal gland, suggesting adrenal metastasis. With a clinical diagnosis of retroperitoneal liposarcoma, we administered preoperative radiation therapy and performed a bilateral tumor resection. On postoperative day 9, a surgical site infection occurred, necessitating incisional drainage and the administration of intravenous antibiotics. The histopathological diagnosis was bilateral myelolipoma of the adrenal glands.

Conclusion

In cases of bilateral retroperitoneal tumors with a large fat component, adrenal myelolipoma should be considered in the differential diagnosis to avoid overtreatment.