Upper New York State Society of Cytology, Inc.

Interesting Case 1

Submitted by: Sharon Leo, MS, CT(ASCP), CMIAC

University of Rochester Medical Center, Rochester, NY

History

A 37 year-old woman had annual follow up screening for an uterine sarcoma ten years earlier. All prior screenings had been negative. A 1 cm right adrenal mass was noted on the current abdominal CT and a fine-needle aspiration biopsy was performed.

Cytologic Findings

The background of the smear was hemorrhagic and moderately cellular. The mixed hematopoietic cell population was composed of normal cells. Megakaryocytes, with dense eosinophilic cytoplasm, were numerous. The nuclei of the megakaryocytes were single, multiple and often multi-lobulated. Some megakaryocyte nuclei were moderately hyperchromatic with occasional coarse chromatin. Many stripped multi-lobulated nuclei were present in the background. Occasional mature adipose cells were identified. No epithelial component was present.

*( Air dry slides were not available on this case.)

Diagnosis/Discussion

Cellular evidence of adrenal myelolipoma.

Adrenal myelolipoma is a benign tumor involving the adrenal cortex. Most are small, asymptomatic, and incidental findings on CT screening for other disorders and/or follow up for a previous cancer (1). Some adrenal myelolipomas may become larger and cause symptoms and others are extra-adrenal occurring in the retroperitoneum and other sites(1). The symptomatic cases may require surgical intervention.

The cellular pattern is a mixture of adipose tissue and benign hematopoietic cells in varying phases of maturation. One cellular component may be more abundant than the other, i.e., adipose cells vs hematopoietic cells. The presence of megakaryocytes is very helpful in making the diagnosis of myelolipoma. The maturation and mixed population of the hematopoietic cells should be helpful in excluding a lymphoma. If the specimen is composed mostly of adipose tissue, a liposarcoma cannot be excluded(1). A differential diagnosis would be used in equivocal cases, i.e., composed of mainly of one cell type. Our case had numerous megakaryocytes and rare adipose cells.

Because of the small size of the myelolipoma, our patient was followed and received no further treatment for the adrenal mass.

References

DeMay RM. The Art & Science of Cytopathology: Volume II. Aspiration Cytology. Chicago: ASCP Press, 1996, pp 1119-20.