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In the case of neoplasms of the adrenal glands that are radiologically and clinically unclear, the indications for surgical resection as well as the subsequent clarification of the entity and dignity on the surgical specimen are difficult. The diagnostics of adrenal neoplasms, in particular the clear distinction between an adenoma and a carcinoma are often tricky from the point of view of a pathologist. In the following, not only the problems of classification and the possibilities of diagnostics in pathology but also an overview of the most important differential diagnoses of other benign and malignant tumors of the adrenal cortex and medulla are presented. [ABSTRACT FROM AUTHOR]

Myelolipoma is a rare benign tumor which is generally detected incidentally. The tumor consists of mature fat tissue and hematopoietic cells that resemble bone marrow. The coexistence of myelolipoma and non-functional adrenocortical adenoma in the same gland is exceedingly rare. We herein present two cases of adrenal myelolipoma in association with non-functional adrenocortical adenoma in left adrenal gland of a 62-year-old woman and non-functional adrenocortical adenoma combined with myelolipoma and endothelial cyst, in right adrenal gland of a 73-years-old man. Microscopically, in the central of the tumor, there was a myelolipomatous area composed of adipocytes and hematopoietic cells surrounded by sheets of adenoma cells. The histopathological diagnosis was “myelolipomatous changes within a non-functional adrenocortical adenoma”. The cases are presented here with their rarity and pathological differential diagnosis.

The authors provide a summary of common adrenal gland tumours encountered in radiology, with an emphasis on CT findings. The first to be mentioned is adrenal adenoma, which is the most common pathological finding of adrenals and which is often incidental. Its lipidrich variant has a typical imaging pattern. Other benign adrenal gland tumours include myelolipoma, which also has typical imaging characteristics, and pheochromocytoma, which may show certain warning CT features, which should draw our attention towards this entity, which often manifests with hypertension. Adrenocortical carcinoma, which has a high case fatality rate and tends to be large, is a very aggressive adrenal gland tumour. Adrenal gland metastases mark the dissemination of carcinoma, which usually has epithelial origin. Unfortunately, metastases have variable characteristics, including their size. The ability to recognise these nosologic entities is important for further management as some of them do not require treatment or follow-up, while, on the contrary, some demand an active therapeutic approach. [ABSTRACT FROM AUTHOR]

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A 53-year-old female patient with long-standing hypertension was evaluated for left flank pain. Abdominal CT scan revealed a 2,8 cm left adrenal mass. Metanephrine, normetanephrine and vanylmandelic acid levels in a 24-hour urine sample were increased. The levels of serum cortisol, renin, aldosteron, calcitonin, parathormone, calcium and phosphate were normal. Left adrenalectomy was performed. There was a nodular mass with a red cut surface in medullary region. The medulla was enlarged in other parts. On microscopic examination, the mass was composed of mature adipose tissue admixed with hematopoietic cells. The medulla was hyperplastic with a corticomedullary ratio of 1:5. After surgery, blood pressure and catecholamine levels normalized. Although myelolipomas are incidental findings, they can rarely present with endocrine dysfunction. In conclusion, surgical excision should be considered in adrenal incidentalomas with characteristic radiographic features of myelolipoma, presenting with biochemical abnormalities. [ABSTRACT FROM AUTHOR]