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Weekly Chest CasesArchive of Old Cases

Case No : 1126 Date 2019-05-27

  • Courtesy of Geewon Lee, Yeon Joo Jeong, Ji Won Lee, So Min Park / Pusan National University Hospital
  • Age/Sex 38 / M
  • Chief Complaintfever, cough and sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Diagnosis With Brief Discussion

Diagnosis
Bronchial myelolipoma
Radiologic Findings
Fig 1-4. Initial chest radiograph and CT scans show total obstruction of the right bronchus intermedius due to low-density endobronchial lesion. The lesion was thought to be secretion due to pneumonia.
Fig 5-8. However, chest radiograph and CT scans obtained one year later still show the endobronchial lesion with internal fat and soft tissue density, and RML/RLL atelectasis.
Fig 9. Bronchoscopic image demonstrates total obstruction of right bronchus intermedius due to endobronchial tumor and secretion. Total mass excision was performed by rigid bronchoscopy.
Fig 10-11. Pathologic results confirmed the mass as bronchial myelolipoma.

Fig. 9

Fig. 10

Fig. 11

Brief Review
Myelolipoma is a rare benign tumor of mesenchymal origin which consists of mature adipose tissue and normal hematopoietic cells. Although they are usually observed in the adrenal glands, about 3% occur in the thorax, mostly in the posterior mediastinum, and only 8 cases arising from the lung have been reported. Mean age at presentation is 60 years (ranging from 45-81) and the sex distribution is predominantly male.
Chest radiograph is normal or may demonstrate haziness associated with atelectasis or pneumonia. On CT, thoracic myelolipoma demonstrates as a completely or partially encapsulated mass, with density dependent on relative proportion of fat (low density) versus hematopoietic tissue (high density).
References
1. Myelolipoma of the lung: a case report and brief review. Journal of clinical pathology, Volume 60, number 6, 2007
2. Primary myelolipoma of the lung: a case of report and review of literature. Polish Journal of Pathology, Volume 63, number 3, 2012
Keywords
airway, benign tumor, myelolipoma,

No. of Applicants : 74

▶ Semi-Correct Answer : 40/74,  54.1%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Lille , France BENOIST CAPON
  • - Other , Korea (South) CHUNGEUN LIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JUWON KIM
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
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