Presacral myelolipoma in a patient with concurrent invasive ductal breast cancer diagnosed by FNC and CNB

Background. Myelolipomas are uncommon benign tumors composed of mature adipose tissue mixed with hematopoietic elements occuring both in adrenal glands and in extra-adrenal locations; the presacral region is the most frequent extra-adrenal location. We present the unique case of a presacral myelolipomadiagnosed by fine needle cytology (FNC) and core needle biopsy (CNB) in a women-with a concurrent breast cancer. Methods. A 55 year-old women was admitted at our institution with the cytological diagnosis of right breast cancer and a non- characterized presacral lump. The images from a noncontrast pelvic CT showed a 5 x 4 cm heterogeneous presacral mass without invasion or erosion of the anterior sacrum and with mixed fat and soft tissue attenuation. The patient uderwent a CT guided FNC and CNB. The air-dried Diff Quick stained smears showed trilineage hematopoietic elements in a background of mature fat cells. The histological slides showed mature adipose tissue admixed with cellular stroma in the absence of bone trabeculae. The stroma consisted of myeloid, erythroid and megakaryocytic forming cell lines. Results. A diagnosis of presacral myelolipoma was made on the basis of these morphological findings in conjunction with the radiological imaging. MR imaging, recommended for further characterization, showed a lobulated mass, with mixed fat/soft tissue signal and without bony invasion. Pre-contrast fat-suppressed images showed loss of signal intensity in the areas which were previously iso-intense to fat, providing further confirmation of a significant fat component of the mass. The patient was treated only for the breast cancer with a right supero–external quadran -tectomy and the ipsilateral axillary lymph node dissection; surgical biopsy of the presacral mass was not performed. Follow up MR at 5 and 16 months of the presacral mass showed stability of the lesion without significant interval change in size, appearance, or signal characteristics.