Paper # 095

Versión en Español

Adrenal Myelolipoma in a patient with Agnogenic Myeloid Metaplasia.

Andréa Rodrigues Cordovil Pires, Luciana Wernersbach Pinto.

[Title] [Introduction] [Materials and Methods] [Pictures] [Discussion] [Bibliography]

RESULTS

• BONE MARROW: biopsy and autopsy examples revealed a hypercellular marrow with predominance of myeloid precursors with less than 5% of blasts and an increased number of megakaryocytes, many of them highly atypical, with variable sizes, bizarre hypersegmented and hyperchromatic nuclei and occasionally forming small clusters. There was only a small increase in reticulin fibers. The final diagnosis was agnogenic myeliod metaplasia, cellular phase.
  
• ADRENAL GLANDS: a well-defined, capsulated tumoral mass measuring 9.0 x 5.5 x 2.5 cm was found in left adrenal gland topography. The external surface was smooth and grayish. The cut surface was bright yellow, with diffuse small red and white areas. Microscopic examination revealed an outer layer of compressed adrenal cortical cells, whereas the center was composed by fat cells and all three lineage hematopoietic cells in a loose conective tissue. These cells were all typical and from all stages of hematopoietic development, resembling normal bone marrow. There was no necrosis, calcification or fibrosis. It was made the diagnosis of myelolipoma of left adrenal gland. The right adrenal gland showed mild extramedullary hematopoiesis.
  
• LIVER: It weighted 2250 g, with some small white spots (less than 0.3 cm), seen in external and cut surfaces and a firm white nodule of 0.2 x 0.2 cm. Microscopicaly there was mild extramedullary hematopoiesis, mild nuclear glycogen deposit and an biliary duct adenoma (small firm white nodule).
  
• SPLEEN: It weighted 950 g, almost ten times its normal weight. The cut surface was reddish and soft due to extramedullary hematopoiesis.
  
• LYMPHNODES: There were supurative lymphadenitis and foci of extramedullary hematopoiesis.
  
• LUNGS: Showed severe bronchopneumonia, focal atelectasis and focal thromboembolism of small arteries.
  
• OTHER DIAGNOSIS:

  Pleural ( 80 and 70 ml), pericardial (70 ml) and peritoneal effusions (130 ml).

  Old myocardial infarct in inferior wall of left ventricle

  Chronic pyelonephritis

  Granulomatous reaction compatible with leprosy

  Severe systemic atherosclerosis

  Chronic pancreatitis with focal agudization

  Nodular goiter

  Traumatic ulcerative esophagitis

  Chronic gastritis

• Title
• Introduction
• Materials and Methods
• Pictures
• Discussion
• Bibliography