대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1381 Date 2024-04-10

  • Courtesy of Woo Hyeon Lim,Ji Young Lee, Hye Soo Cho / Seoul National University Hospital
  • Age/Sex 61 / M
  • Chief ComplaintRadiologic abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Thoracic myelolipoma
Radiologic Findings
Fig 1. Chest PA shows mass-like opacity along the descending thoracic aorta.
Fig 2-3. CT scans reveal well-defined heterogeneous hyper and hypo-attenuated (fat-attenuation) mass in the posterior mediastinum. Adjacent bony structures are intact.
Fig 4-5. In MRI, the most of the mass is consisted of fat, and non-fatty components show linear T2-hypersignal intensity with accompanied contrast-enhancement.
Brief Review
Myelolipomas are rare tumors with hematopoietic cells and mature adipocytes, and thoracic involvement is extremely rare (~3% of myelolipomas). The mediastinal myelolipoma does not have any pathognomonic signs or symptoms. Imaging findings could vary according to the proportion of elements in the tumors. In CT imaging, myeloid elements show high attenuation values, while fat components have low attenuation values. In MRI, fat components could be easily differentiated by characteristic T1-hypersignal intensity and subsequent fat saturation. After the administration of contrast media, myeloid components show contrast enhancement, while fat components do not. The presence of calcification within the tumor has not been reported so far. At present, there is no standard treatment for mediastinal myelolipoma, and VATS-mediastinal mass excision seems to be a satisfactory choice.
References
1. Huang W, Zhao Y, Yin X et-al. Primary myelolipoma of the lung: a case of report and review of literature. Pol J Pathol. 2013;63 (3): 204-6
2. Xiong Y, Wang Y, Lin Y. Primary myelolipoma in posterior mediastinum. J Thorac Dis. 2014 Sep;6(9):E181-7.
3. Yao WQ, Wang WY, Lui XJ et al. Mediastinal myelolipoma/extramedullary hematopoiesis presenting as a mass: rare differential diagnosis among mediastinal tumors. Int J Clin Exp Pathol. 2018 May 1;11(5):2714-20.
Keywords

No. of Applicants : 76

▶ Correct Answer : 20/76,  26.3%
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Uniyersity of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - , Japan KEISUKE HIDAKA
  • - , Japan YOSHIKI ISHII
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Juntendo University , Japan YUTAKA IKENOUCHI
▶ Correct Answer as Differential Diagnosis : 14/76,  18.4%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Senegal AXEL MBUYU KAYEMBE
  • - Other , Korea (South) SEONGSU KANG
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , Japan SHUNJIRO NOGUCHI
  • - Ome Medical Center , Japan MIKIYA FUJII
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 23/76,  30.3%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan MASAFUMI KAIUME
  • - CHCB , France LE GUEN RAPHAEL
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - , Italy PAOLO BALDASSARI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - , Korea (South) KANGHWI LEE
  • - Other , Korea (South) HYEJOO PARK
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - University of the Ryukyus , Japan Nanae Tsuchiya
  • - Mie university , Japan SHIKO OKABE
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - University of Yamanashi , Japan TIHAN WUMU
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
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