Discussion
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