Hepatic myelolipoma
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IsHepatic myelolipoma is a rare, benign fat containing lesion of the liver, usually asymptomatic, found incidentally. Its diagnosis by imaging remains difficult because of lack of pathognomonic signs. The definite diagnosis is by resection or biopsy.
Epidemiology
Extremely rare. Only 17 cases described in the literature.
Clinical Presentation
AsymptomaticUsually asymptomatic and incidentally noted.
Pathology
The lipomatous tumorstumours of the liver are uncommon. Their composition is of fatty, muscular, haemopoetichaemopoietic, and vascular tissues. According to the predominant tissue type they include angiomyolipomas, myolipomaslipomas and myelolipomas.
The hepatic myelolipomas consistsconsist of adipose and myeloid tissue.
Their Their pathogenesis includingincluding hepatic localization remains unclear, it has been suggested an association with liver cell metaplasia, other theories are related withto endocrine factors.
Radiographic Features
Ultrasound
Ultrasound
Ultrasound
Non-specific findings. Appears as ana hyperechoic well-circumscribed, lobulated mass.
CT
Hypodense mass, with fatty attenuations between -20 and -100 UH. In some cases, the attenuation value could be greater than zero, and this is associate with the proportions of fat and other elements in the tumortumour.
- NECT:
Lobulatedlobulated wellcircunscribe-circumscribed hypodensemassmass with fat attenuations. -
Arterialarterial phase: No enhancement. -
Portalportal venous phase: Remains hypodense without enhancement.
MR
MRI
Non-specific findings.
WellAppears as a well-defined mass with a pseudocapsule, heterogenous fatty architecture and contents with elevated attenuation.
Treatment and Prognosis
Malignant transformation has not been described.
Surgical Surgical treatment is reserved for symptomatic patients or in case of diagnosisdiagnostic uncertainty.
History
and etymologyThe first case of ana hepatic myelolipoma was described in France by Grosdidier in 1973.
Differential Diagnosis
-<p>Is a rare, benign <a href="/articles/fat-containing-liver-lesions">fat containing lesion of the liver</a>, usually asymptomatic, found incidentally. Its diagnosis by imaging remains difficult because of lack of pathognomonic signs. The definite diagnosis is by resection or biopsy. </p><h5>Epidemiology </h5><p>Extremely rare. Only 17 cases described in literature. </p><h5>Clinical Presentation</h5><p>Asymptomatic. </p><h5>Pathology</h5><p>The lipomatous tumors of the liver are uncommon. Their composition is of fatty, muscular, haemopoetic, and vascular tissues. According to the predominant tissue type they include angiomyolipomas, myolipomas and myelolipomas. </p><p>The hepatic myelolipomas consists of adipose and myeloid tissue. </p><p>Their pathogenesis including hepatic localization remains unclear, it has been suggested an association with liver cell metaplasia, other theories are related with endocrine factors. </p><h5>Radiographic Features</h5><h6>Ultrasound</h6><p>Non-specific findings. Appears as an hyperechoic well-circumscribed, lobulated mass. </p><h6>CT</h6><p>Hypodense mass, with fatty attenuations between -20 and -100 UH. In some cases, the attenuation value could be greater than zero, and this is associate with the proportions of fat and other elements in the tumor. </p><ul>-<li>NECT: Lobulated well circunscribe hypodense mass with fat attenuations. </li>-<li>Arterial phase: No enhancement. </li>-<li>Portal venous phase: Remains hypodense without enhancement. </li>-</ul><h6>MR</h6><p>Non-specific findings. </p><p>Well-defined mass with a pseudocapsule, heterogenous fatty architecture and contents with elevated attenuation. </p><h5>-<br>Treatment and Prognosis</h5><p>Malignant transformation has not been described. </p><p>Surgical treatment is reserved for symptomatic patients or in case of diagnosis uncertainty. </p><h5>History</h5><p>The first case of an hepatic myelolipoma was described in France by Grosdidier in 1973. </p><h5>Differential Diagnosis</h5><p><a href="/articles/hepatic-adrenal-rest-tumour">Hepatic adrenal rest tumor</a></p><p><a href="/articles/focal-nodular-hyperplasia">Hepatic focal nodular hyperplasia</a></p><p><a href="/articles/hepatic-adenoma">Adenomas</a></p><p><a href="/articles/hepatic-angiomyolipoma-1">Hepatic angiomyolipomas</a></p><p><a href="/articles/hepatic-adenoma">Hepatic lipomas</a></p><p><a href="/articles/flash-filling-hepatic-venous-malformation">Haemangiomas</a></p><p> </p>- +<p><strong>Hepatic myelolipoma</strong> is a rare, benign <a href="/articles/fat-containing-liver-lesions">fat containing lesion of the liver</a>, usually asymptomatic, found incidentally. Its diagnosis by imaging remains difficult because of lack of pathognomonic signs. The definite diagnosis is by resection or biopsy. </p><h4>Epidemiology </h4><p>Extremely rare. Only 17 cases described in the literature. </p><h4>Clinical Presentation</h4><p>Usually asymptomatic and incidentally noted. </p><h4>Pathology</h4><p>The lipomatous tumours of the liver are uncommon. Their composition is of fatty, muscular, haemopoietic, and vascular tissues. According to the predominant tissue type they include <a href="/articles/hepatic-angiomyolipoma-1">angiomyolipomas</a>, <a href="/articles/hepatic-lipoma-2">lipomas</a> and myelolipomas. </p><p>The hepatic myelolipomas consist of adipose and myeloid tissue. Their pathogenesis including hepatic localization remains unclear, it has been suggested an association with liver cell metaplasia, other theories are related to endocrine factors. </p><h4>Radiographic Features</h4><h5>Ultrasound</h5><p>Appears as a hyperechoic well-circumscribed, lobulated mass. </p><h5>CT</h5><p>Hypodense mass, with fatty attenuations between -20 and -100 UH. In some cases, the attenuation value could be greater than zero, and this is associate with the proportions of fat and other elements in the tumour. </p><ul>
- +<li>NECT: lobulated well-circumscribed hypodense mass with fat attenuations</li>
- +<li>arterial phase: No enhancement</li>
- +<li>portal venous phase: Remains hypodense without enhancement</li>
- +</ul><h5>MRI</h5><p>Appears as a well-defined mass with a pseudocapsule, heterogenous fatty architecture and contents with elevated attenuation. </p><h4>Treatment and Prognosis</h4><p>Malignant transformation has not been described. Surgical treatment is reserved for symptomatic patients or in case of diagnostic uncertainty. </p><h4>History and etymology</h4><p>The first case of a hepatic myelolipoma was described in France by <strong>Grosdidier</strong> in 1973. </p><h5>Differential Diagnosis</h5><ul>
- +<li><a href="/articles/hepatic-angiomyolipoma-1">hepatic angiomyolipomas</a></li>
- +<li><a href="/articles/hepatic-adenoma">hepatic lipomas</a></li>
- +<li><a href="/articles/hepatic-adenoma">hepatic adenomas</a></li>
- +<li><a href="/articles/flash-filling-hepatic-venous-malformation">haemangiomas</a></li>
- +<li><a href="/articles/hepatic-adrenal-rest-tumour">hepatic adrenal rest tumour</a></li>
- +<li><a href="/articles/focal-nodular-hyperplasia">hepatic focal nodular hyperplasia</a></li>
- +</ul>
References changed:
- 1. Andreu F. Costa, Seng Thipphavong, Thomas Arnason, Ashleigh E. Stueck, Sharon E. Clarke. Fat-Containing Liver Lesions on Imaging: Detection and Differential Diagnosis. (2017) American Journal of Roentgenology. 210 (1): 68-77. <a href="https://doi.org/10.2214/AJR.17.18136">doi:10.2214/AJR.17.18136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29064755">Pubmed</a> <span class="ref_v4"></span>
- 1. Andreu F. Costa, Seng Thipphavong, Thomas Arnason, Ashleigh E. Stueck, Sharon E. Clarke. Fat-Containing Liver Lesions on Imaging: Detection and Differential Diagnosis. (2017) American Journal of Roentgenology. 210 (1): 68-77. <a href="https://doi.org/10.2214/AJR.17.18136">doi:10.2214/AJR.17.18136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29064755">Pubmed</a> <span class="ref_v4"></span>
- 2. Piotr Szyber, Wojciech Polak, Dariusz Patrzalek, et-al. Hepatic myelolipoma - a challenging diagnostic problem. Case report and review of the literature. Case Rep Clin Pract Rev, 2003; 4 (3) 214-216
- 3. Gallo M, Mineur L, Emptas H, Costes V, Ramos J. [Hepatic myelolipoma: A rare entity, case report and review of the literature]. (2017) Annales de pathologie. 37 (5): 415-419. <a href="https://doi.org/10.1016/j.annpat.2017.06.010">doi:10.1016/j.annpat.2017.06.010</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28935415">Pubmed</a> <span class="ref_v4"></span>
- Andreu F. Costa, Seng Thipphavong, Thomas Arnason, Ashleigh E. Stueck, Sharon E. Clarke. Fat-Containing Liver Lesions on Imaging: Detection and Differential Diagnosis. (2017) American Journal of Roentgenology. 210 (1): 68-77. <a href="https://doi.org/10.2214/AJR.17.18136">doi:10.2214/AJR.17.18136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29064755">Pubmed</a> <span class="ref_v4"></span> Piotr Szyber, Wojciech Polak, Dariusz Patrzalek, Jerzy Rabczynski, Stanislaw Pawlowski. Hepatic myelolipoma- a challenging diagnostic problem. Case report and review of the literature. (2003) Case Rep Clin Pract Rev, 2003; 4 (3) 214-216 Gallo M, Mineur L, Emptas H, Costes V, Ramos J. [Hepatic myelolipoma: A rare entity, case report and review of the literature]. (2017) Annales de pathologie. 37 (5): 415-419. <a href="https://doi.org/10.1016/j.annpat.2017.06.010">doi:10.1016/j.annpat.2017.06.010</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28935415">Pubmed</a> <span class="ref_v4"></span>
- 1. Andreu F. Costa, Seng Thipphavong, Thomas Arnason, Ashleigh E. Stueck, Sharon E. Clarke. Fat-Containing Liver Lesions on Imaging: Detection and Differential Diagnosis. (2017) American Journal of Roentgenology. 210 (1): 68-77. <a href="https://doi.org/10.2214/AJR.17.18136">doi:10.2214/AJR.17.18136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29064755">Pubmed</a> <span class="ref_v4"></span> Piotr Szyber, Wojciech Polak, Dariusz Patrzalek, Jerzy Rabczynski, Stanislaw Pawlowski. Hepatic myelolipoma- a challenging diagnostic problem. Case report and review of the literature. (2003) Case Rep Clin Pract Rev, 2003; 4 (3) 214-216 Gallo M, Mineur L, Emptas H, Costes V, Ramos J. [Hepatic myelolipoma: A rare entity, case report and review of the literature]. (2017) Annales de pathologie. 37 (5): 415-419. <a href="https://doi.org/10.1016/j.annpat.2017.06.010">doi:10.1016/j.annpat.2017.06.010</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28935415">Pubmed</a> <span class="ref_v4"></span>
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