An unusual case of a posterior mediastinal myelolipoma in a patient with mediterranean anemia
Piergiorgio Muriana, Giampiero Negri
The Pan African Medical Journal. 2018;31:58. doi:10.11604/pamj.2018.31.58.17041

Innovations in Measles Elimination Innovations in Measles Elimination
"Better health through knowledge sharing and information dissemination "

Images in medicine

An unusual case of a posterior mediastinal myelolipoma in a patient with mediterranean anemia

Cite this: The Pan African Medical Journal. 2018;31:58. doi:10.11604/pamj.2018.31.58.17041

Received: 06/09/2018 - Accepted: 24/09/2018 - Published: 27/09/2018

Key words: Myelolipoma, mediastinal tumor, mediterranean anemia, differential diagnosis

© Piergiorgio Muriana et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/31/58/full

Corresponding author: Piergiorgio Muriana, Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy (muriana.piergiorgio@hsr.it)


An unusual case of a posterior mediastinal myelolipoma in a patient with mediterranean anemia

Piergiorgio Muriana1,&, Giampiero Negri1

 

1Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy

 

 

&Corresponding author
Piergiorgio Muriana, Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy

 

 

Image in medicine    Down

A 34-year-old male was admitted at our Department for back pain and a right paravertebral mass at the chest x-ray. His medical history was positive for beta-thalassemia major with normal routinely blood tests. A contrast-enhanced chest computed-tomography showed a 26 x 15 mm right solid paravertebral round-shaped lesion at T8-T9 levels, with a small inner component of adipose tissue (Panel A). Contrast-enhanced magnetic resonance-imaging showed irregular low signal intensity in long TR sequences, with mild enhancement after contrast administration (Panel B, Panel C). Surgical excision of the lesion by means of video-assisted thoracic surgery was scheduled for both definitive diagnosis and therapeutic purpose. Histopathologic examination revealed the presence of adipocytes mixed with mature hematopoietic cells (Panel D). Differential diagnosis included mediastinal myelolipoma (MM) and extramedullary hematopoiesis (EH). In fact, both of them are composed of fat and hematopoietic tissue. Mediterranean anemia is a common finding in patients with EH. However, the presence of a single capsulated tumor and the absence of abnormal hematopoietic cells led to a final diagnosis of MM. The patient is currently alive without recurrence 23 months after surgery. Myelolipoma is a benign tumor usually arising in adrenal glands. Less than 50 cases of MM have been described in the literature to date. Many Authors currently support the role of a triggering condition (both metabolic, infectious and neoplastic), which might be responsible for the growth of ectopic adrenal or hematopoietic tissue. Patient's history, radiologic, and pathologic features must all be taken into due consideration in differential diagnosis between MM and EH.

 

 

Figure 1: (A) axial chest CT-scan; (B) axial chest MRI; (C) coronal chest MRI; (D) microscopic specimen (stained with hematoxylin and eosin) of MM showing the presence of mature adipocytes (left), and hematopoietic tissue (right), consisting of erythroid and myeloid cells at different stages of differentiation. In addition, scattered megakaryocytes, rare lymphocytes and plasmacells; original magnification 40X, inset 200X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 32 (January - April 2019)

Article tools

PDF (317 Kb)
Contact the corresponding author
Download to Citation Manager
EndNote
Reference Manager
Zotero
BibTex
ProCite


This article authors

On Pubmed
On Google Scholar

Navigate this article

Keywords

Myelolipoma
Mediastinal tumor
Mediterranean anemia
Differential diagnosis

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics
PAMJ Authors services
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2019 - Pan African Medical Journal. All rights reserved