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Adrenal myelolipomas (AM) may present with abdominal distension, pain, rupture, hemorrhage or other complications. Indications for surgery are still debatable. It is possible that larger size may be a risk factor for symptoms or complications in AM. To compare the clinical and pathological characteristics between giant AM (>10 cm) and AM <10 cm. Retrospective data analysis was done on 26 of 32 patients with myelolipoma who underwent surgery between January, 2005 and July, 2012. Patients were divided in two groups: Group 1 (n = 14) with giant AM > 10 cm and group 2 (n = 12) AM < 10 cm. Results were analyzed using independent sample t-test (SPSS v.17). Twenty-six myelolipomas managed surgically were identified from 338 adrenal tumors. None were functioning on biochemical evaluation. Comparing group 1 vs 2, the differences noted were: Commonest age group at presentation was 4th decade vs 5th decade, clinical presentation with abdominal pain was 11 vs 7 (p = 0.05), surgical approach was open in 11 vs 6, and laparoscopic in 3 vs 6 (p = 0.03), mean tumor size was 15.57 vs 6.67 cm, mean tumor weight 794 vs 93 gm, internal hemorrhage on histopathology in 14 vs 10 (p = 0.05). Giant AM have a significantly higher rate of symptomatic presentation, pathological features of hemorrhage and necrosis and requirement for open surgery as compared to myelolipomas <10 cm in our series.

Do Giant Adrenal Myelolipomas Behave Differently? A Clinicopathological Comparative Study