Case 122 - Discussion

Uploaded: 2007-10-09, Updated: 2007-10-09



CD20 CD23
The immunoprofile of the gingival lesion

is similar to that of the infiltrate in the adrenal mass.

  CLL Involving Gingiva and Adrenal Myelolipoma

Myelolipoma is a rare benign neoplasm, usually discovered incidentally at autopsy or on imaging studies performed for other clinical indications. Myelolipoma most commonly occurs in the 5th to 7th decades of life with no sex predilection, and the incidence varies from 0.08-0.4% at autopsy [1-7]. Most myelolipomas occur within the adrenal gland, although they are rarely encountered at extra-adrenal locations, such as the presacral and pararenal retroperitoneum, mediastinum, liver, and muscular fascia. The pathogenesis of myelolipoma remains undetermined [1, 2], although several hypotheses have been proposed, including retention of embryonic rests, extramedullary hematopoiesis and metaplastic origin [2]. Myelolipomas are usually unilateral, small and asymptomatic. Microscopically, adrenal myelolipoma is composed of mature adipocytes with interspersed hematopoietic cells at variable ratios [1, 2, 3].

To our knowledge, this is the first case of myelolipoma with CLL involvement. In fact, solid tumor infiltration by CLL has rarely been reported. The tumor in this case was incidental at autopsy with leukemic involvement confirmed by immunohistochemical staining.

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  2. Meaglia JP, Schmidt JD: Natural history of an adrenal myelolipoma 1992 J Urol 147:1089.
  3. Sharma MC, Kashyap S, Sharma R, Chumber S, Sood R, Chahal R Symptomatic adrenal myelolipoma. Clinicopathological analysis of 7 cases and brief review of literature. Urol Int 1997; 59: 119-24.
  4. Sanders R, Bissada N, Curry N, Gordon B. Clinical spectrum of adrenal myelolipoma: Analysis of 8 tumors in 7 patients. J Urol 1995; 153: 1791-3.
  5. Dieckmann KP, Hamm B, Pichartz H, Jonas D, Baucer HW.Adrenal myelolipoma : clinical radiologic and histologic features. Urology 1987; 29: 1-8.
  6. Bhansali Aa, Dash RJa, Singh SKb, Behra Ac, Singh Pd, Radotra BDe. Adrenal Myelolipoma: Profile of Six Patients with a Brief Review of Literature. International Journal of Endocrinology and Metabolism. Vol1,No1 March2003.
  7. Goetz, SP, TH Niemann, RA Robinson, and MB. Cohen. Hematopoietic elements associated with adrenal glands: a study of the spectrum of change in nine cases. Arch Pathol Lab Med 1994;118:895-896.