Adrenal Myelolipoma Inside an Adrenal Cortical Adenoma.

A case of an incidental adrenal myelolipoma inside a non-functioning adrenal cortical adenoma is reported. A 65-year-old woman with a history of right-sided clear cell renal cell carcinoma presented for a follow-up of a left-sided adrenal mass first noted incidentally on a previous renal cell carcinoma workup. Macroscopically, it was a well-circumscribed, tan-yellow mass with gritty hemorrhage. Histopathologic evaluation showed the proliferation of clear to eosinophilic cells, filled with small vacuoles with a well-delineated lesion composed of mature adipose tissue and bone marrow elements. Also, this focus of myelolipoma revealed adenoma cells inside its borders; and interestingly, trilineage hematopoiesis was mostly observed near the adenoma-myelolipoma interfaces. To our knowledge, this is a unique report mentioning some additional features about the interfaces of these lesions. It can be suggested that the presence of adrenal cortical adenoma played the main stressor role in giving rise to myelolipoma and myelolipoma, being closer to the adenoma's vascular network, caused the different interface features.