VCOM Research Day Program Book 2023

Medical Student Research Case Reports

14 Presacral Myelolipoma: An Unusual Case Report with a 16 Year History

Jordan Gayfield; Keith Stephenson, MD Corresponding author: jgayfield@vt.vcom.edu

Edward Via College of Osteopathic Medicine-Virginia Campus Carlion Clinic General Surgery Christiansburg and Blacksburg

establish the benign course of presacral myelolipomas has guided the recommendations regarding surgical or conservative management. This report seeks to comment on the natural history, diagnosis, and management of presacral myelolipomas. Report of Case: W e report a case of a presacral myelolipoma in a 72-year-old woman, after imaging studies demonstrated its natural course for 16 years. The mass was incidentally detected at 4 x 1.9 cm and gradually increased in size to 5.3 x 3.1 cm, an average of 1 mm per year circumferentially. Over the course of 16 years, the lesion remained asymptomatic, which suggested a non-aggressive neoplasm without the potential to rupture or spontaneously hemorrhage.

A computed tomography (CT)-guided biopsy with histology confirmed the diagnosis. The patient was managed non-surgically. Conclusion: For asymptomatic presacral myelolipomas found incidentally, the benign history of this lesion in the longitudinal case we present suggests that it can be left undisturbed, especially in elderly patients or those with comorbidities that pose an increased risk for peri and postoperative surgical outcomes. However, due to the wide range of tumors that can present in the presacral space, a definitive diagnosis should be obtained prior to opting to manage non-surgically.

Background: Presacral myelolipomas are a rare, benign subset of extra-adrenal myelolipomas named according to their location. Histologically, they are of mesenchymal origin, largely composed of mature adipocytes intermixed with hematopoietic cells. There are 41 reported cases of presacral myelolipomas in English literature. Due to the unusual diagnosis, the etiology, natural history, frequency, and growth rate of these tumors have yet to be fully explained. Discovery is often made incidentally and most commonly between the fifth and seventh decade of life. It has been suggested to surgically remove the lesion if symptomatic or asymptomatic, but larger than 4 cm, due to the potential for rupture, hemorrhage, or mass effect related to tumor growth during the patient’s life expectancy. The lack of longitudinal data to

141 2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y