Clinicopathological analysis of Adrenal Myelolipoma and predicting Complications Based on Histology: An experience from a tertiary care center

Introduction: Adrenal myelolipoma (AML) is a benign tumor that histologically comprises a variable admixture of hematopoietic cells and adipose tissue. Most of these tumors are nonfunctional and asymptomatic but can sometimes pose challenges in differential diagnosis. We present a cohort of 115 cases of AML, emphasizing their clinicoradiological and pathological features, associated adrenal lesions, and tumor variables inferring the complications. Materials and Methods: All proven cases of AML who underwent adrenalectomy from 2003 to 2023 were included. Data on patient demography, radiological details, follow-up, and complete pathological examination of the tumor were studied. Results: Out of 115 patients with AML, 54 were males aged 17-73. Radiological diagnosis could correctly be made in 80% of patients (92/115). Intratumoral calcifications and necrosis were noted in tumors exceeding 6 cm in size and were present in 4.3% and 6.9% of the tumors, respectively, whereas intratumoral hemorrhage is commonly observed (80%). Statistically, a significant correlation was noted between the frequency of tumor complications and tumor weight (p value <0.001) and dimensions (p value <0.001). All patients were managed surgically with either open adrenalectomy (52.2%) or laparoscopy converted to open surgery (11.3% patients). A significant correlation was observed between tumor size and type of surgery needed (p value=0.001), with open surgery needed when tumor size exceeded 6 cm. Conclusion: Tumor variables, i.e., size, weight, and fat-to-myeloid proportion (>1) may predict tumor complications and guide the type of surgery needed.