# Too Massive and Too Atypical to Be Benign: The Unexpected Face of a Giant Adrenal Myelolipoma

## TL;DR

This paper presents a rare case of a large adrenal myelolipoma that was initially mistaken for a malignant tumor due to its size and appearance.

## Contribution

The novelty lies in highlighting the diagnostic challenges of giant adrenal myelolipomas and the importance of histology for accurate diagnosis.

## Key findings

- Giant adrenal myelolipomas can mimic malignant tumors radiologically.
- Histological evaluation is essential for definitive diagnosis.
- Surgery is recommended for large or uncertain adrenal masses.

## Abstract

Adrenal myelolipomas (AMLs) are rare benign tumors composed of adipose and myeloid tissue. They are most often discovered incidentally and generally remain small in size. However, giant forms can radiologically mimic a malignant tumor, leading to aggressive investigations and treatment. We report the case of a patient who was hospitalized for investigation of a right adrenal mass, revealed by lumbar pain. An abdominal CT scan showed a large, heterodense interhepatorenal mass exerting a mass effect on the ipsilateral kidney with peripheral calcifications. The mass was excised and submitted for histological evaluation. The results of the histological study revealed an AML. Giant myelolipomas are rare and represent a real diagnostic challenge. Their large size, heterogeneous components, and necrotic or hemorrhagic changes can mimic a malignant tumor. Surgery remains indicated in cases of diagnostic uncertainty, compressive symptoms, or tumors larger than 6 cm. Histology remains the only way to establish a definitive diagnosis. This case highlights the difficulty of distinguishing a giant myelolipoma from a malignant adrenal tumor.