Myelolipomas are benign tumors or tumor-like lesions that occur very rarely. Myelolipomas consist of mature adipose tissue as well as variable amounts of hematopoietic tissue. In most cases, they occur in the area of the adrenal gland. The name of the disease was coined by the French pathologist Charles Oberling.
What is a myelolipoma?
Myelolipomas represent a rare disorder in which benign tumors occur. These are usually localized in the area of the kidneys. Myelolipomas occur with equal frequency in women and men, with a peak age range from 50 to 70 years of age. In autopsy studies, myelolipomas are found in 0.08 to 0.4 percent of all cases. Myelolipomas are tumors of yellowish to brownish color that can range in size from a few millimeters to 30 centimeters. However, the tumors are not encapsulated. Usually, they occur singly and unilaterally in the area of the adrenal gland. In rarer cases, they can also occur bilaterally and sometimes outside the adrenal gland. They can occur, for example, in the liver, retroperitoneum, muscle fascia or mediastinum. Microscopic analysis shows that myelolipomas are mainly composed of mature adipose tissue and myeloid cells. In some cases, myelolipomas are also found to have bony metaplasia or hemorrhage.
Causes
The causes responsible for the development of myelolipomas have not been adequately explored and are therefore largely unknown. However, various theories exist about potential causes of myelolipomas. For example, it is under discussion that the transformation (medical term metaplasia) of so-called reticuloendothelial cells in blood capillaries could be a possible cause. Such transformations may occur as a result of certain stimuli such as stress, infection, or necrosis. It is also sometimes considered that myelolipoma is a site where extramedullary hematopoiesis occurs. This refers to a form of hematopoiesis that occurs outside of the bone marrow. More recent studies indicate that both the bone marrow-like component and the fat component of the myelolipoma are constructed in the same way. This leads to the conclusion that myelolipomas may actually be true new formations of body tissue (medical term neoplasia). In addition, the literature discusses a possible association of myelolipomas with congenital enlargement of the adrenal glands (medical term adrenal hyperplasia).
Symptoms, complaints, and signs
Basically, various symptoms can occur with existing myelolipomas. However, in the majority of cases, the tumors are asymptomatic. This means that the myelolipomas do not cause any noticeable symptoms or discomfort and, for this reason, may not be noticed by the affected individuals. In such cases, myelolipomas are usually only detected by chance, for example during radiological examinations. If they remain undetected and do not show any symptoms, myelolipomas may only be found during autopsy. Symptoms felt by the affected patients often only occur with larger tumors. In such cases, myelolipomas suffer from abdominal and flank pain, for example. Only very rarely is there a connection to endocrine disorders such as Conn’s syndrome, Cushing’s syndrome, or inherited adrenal hyperplasia, in which case corresponding symptoms are seen.
Diagnosis and course of the disease
If typical symptoms of a myelolipoma appear, a specialist should be consulted immediately, who will order the necessary measures. Radiological examinations that provide images of the internal organs and possible tumors are considered for the diagnosis of myelolipoma. Medical examinations are significant in any case, as the disease must be distinguished from other, more serious diseases with similar symptoms. In most cases, the prognosis of myelolipomas is relatively good. So far, no malignant degeneration of myelolipoma into malignant tumors has been observed. In rare cases, complications may occur in which bleeding occurs. These are usually caused by traumatic or spontaneously occurring tumor ruptures.Assured data on mortality associated with myelolipomas are not possible due to the rarity of the tumors.
Complications
Because myelolipoma is a tumor disease in most cases, the usual complications and risks of cancer occur with this complaint. In the worst cases, the tumor can spread to other regions, damaging more healthy tissue. In some cases, this also reduces the patient’s life expectancy. It is therefore not uncommon for a myelolipoma to remain undetected, so that early treatment is not possible. Due to the disease, most patients suffer from pain in the abdomen or flanks. This pain can also spread to the back or other areas of the body and cause discomfort there. The quality of life is significantly reduced by this disease. Usually, myelolipoma only needs to be treated and removed if it causes discomfort or if the cancer could spread. In most cases, no treatment is performed if there are no symptoms. There are no further complications and the course of the disease is usually positive. If treatment is successful, there is also no reduction in the patient’s life expectancy due to myelolipoma.
When should you see a doctor?
When signs of a tumor are noticed, medical advice should always be sought. Individuals who notice unusual lumps, growths, or skin changes are best to speak with their primary care physician immediately. Medical help is also needed if there is a worsening of health that is not due to any other cause. The doctor can diagnose a myelolipoma and then initiate treatment immediately. If this is done early, serious complications can be averted in many cases. People who have already had a myelolipoma or another benign tumor should inform the appropriate physician if symptoms recur. People with previous diseases and other dispositions that favor the development of a tumor should also go to the doctor with mentioned complaints. A myelolipoma can be diagnosed by a general practitioner. Further treatment is carried out by internists and specialists for tumors and metastases. During the period of treatment, regular consultation with the physician is necessary, since complications can occur even with benign tumors, which must be treated immediately.
Treatment and therapy
Therapeutic measures in the presence of a myelolipoma depend on the individual clinical picture as well as the severity of the lesion. In myelolipomas that are characterized by small size and do not cause symptoms in affected patients, treatment of the myelolipoma can be avoided for the time being. In this case, the myelolipoma only needs to undergo regular specialist examination in order to contain any changes or potential complications that may occur in a timely manner. Myelolipomas associated with noticeable symptoms are usually treated by surgical removal of the affected adrenal gland.
Outlook and prognosis
Myelolipomas usually offer a good prognosis. Degeneration does not occur, and tumor rupture is rare. Occasionally, the renal tumor causes symptoms such as abdominal and flank pain. Endocrine disorders such as Conn syndrome may also occur. These and other associated symptoms worsen the quality of life, but are not life-threatening. In most cases, drug treatment is possible. Myelolipomas themselves are surgically removed. Small tumors do not require treatment. However, regular check-ups by the physician are necessary so that any degeneration can be treated at an early stage. When myelolipomas degenerate, the prognosis worsens. The survival rate depends on which stage the disease is in. The symptom pattern also affects the prognosis. Life expectancy depends on the course of the tumor disease. With successful therapy, mortality is not reduced. The patient can lead a symptom-free life and only has to change his diet to relieve the kidneys. Exact data are not available due to the rarity of the condition.The specialist in charge can make a prognosis based on the symptom picture and consult comparable cases to evaluate life expectancy.
Prevention
Concrete measures for the prevention of myelolipomas do not yet exist according to the current state of knowledge of medical science. There is only evidence that specific external stimuli may promote the development of myelolipoma in humans. Such stimuli include, for example, psychological and physical stress, various infections or necrosis, which is understood to mean the death of cells in the living organism. If typical signs of myelolipoma occur, such as pain in the abdomen and flanks, a physician should be consulted immediately to initiate adequate therapeutic measures.
Follow-up
In most cases of myelolipoma, the measures of a follow-up are very limited. In this case, the affected person is primarily dependent on a rapid and on an early diagnosis of the disease, so that it does not come to further complications or to a further worsening of the symptoms. As a rule, myelolipoma does not heal on its own, so that those affected should ideally consult a doctor at the first signs and symptoms of the disease. Treatment is not always necessary for myelolipoma, although the condition of the tumor should be monitored regularly by a physician. In some cases, surgical intervention is necessary, which can completely remove the tumor or the affected organ. After such an operation, the patient should rest and take care of his body. They should refrain from exertion or other stressful and physical activities. Regular check-ups by a physician are also important after the procedure. It cannot be universally predicted whether myelolipoma will lead to a reduced life expectancy of the affected person. Furthermore, there are usually no special measures of aftercare available to affected individuals with this disease.
Here’s what you can do yourself
The measures affected individuals can take themselves in the presence of a myelolipoma depend on the individual clinical picture and the severity of the lesion. Smaller growths often do not cause symptoms and do not necessarily require treatment. Larger tumors, however, should be clarified and treated by a physician. The patient can support the therapy by taking it easy and keeping close contact with the doctor in charge. If the tumor increases in size, the physician must be informed. Serious complications, such as attacks of pain or even rupture of the tumor, also require rapid clarification. In addition to the prescribed drugs, a number of natural remedies are also available to alleviate the pain. For example, preparations containing arnica and belladonna have proven effective, but calendula ointment can also alleviate the typical symptoms. The use of alternative remedies should be discussed with the physician beforehand. Larger myelolipomas must be surgically removed. The most important self-help measure is to take care of the body after the operation. The surgical wound must be cared for according to the doctor’s instructions, as there is an increased risk of infection. Accompanying this, regular visits to the doctor are indicated in order to detect a possible recurrence at an early stage.
