case_images: PMC3933520_01
case_images: 84-year-old male with presacral myelolipoma. Sagittal (a) and axial ((b), (c)) contrast-enhanced CT images show the presacral mass, spanning from S3 to S5. It presented lobulated contours and a heterogeneous appearance, due to an admixture of soft-tissue and fat elements. The latter had attenuation values of about -40 HU. The mass was located in the retrorectal space and adhered to the sacrum, posteriorly.
case_images: CRIM.RADIOLOGY2014-674365.001.jpg
case_images: PMC3933520_01_CRIM.RADIOLOGY2014-674365.001.jpg
case_images: fig1
case_images: It abutted the sacrum posteriorly and was located between S3 and S5 (Figure 1(a)). The mass presented a heterogeneous appearance due to a mixed fat (attenuation values as low as -40 HU) and soft-tissue composition and had no calcifications (Figures 1(a)-1(c)). T2-weighted sequences (Figures 2(c) and 2(d)). The bladder wall was diffusely thickened suggesting chronic outflow obstruction related to benign prostatic hypertrophy (Figures 1(a) and 2(c)).
case_images: 84-year-old male with presacral myelolipoma. Precontrast T1-weighted (a) and fat-suppressed T1-weighted (b) FSE axial images depicted the presence of macroscopic fat (arrows). The solid hematopoietic elements (asterisk) exhibited intermediate signal on precontrast T2-weighted sagittal (c) and axial (d) images and low-signal intensity on T1-weighted sequences.
case_images: CRIM.RADIOLOGY2014-674365.002.jpg
case_images: PMC3933520_01_CRIM.RADIOLOGY2014-674365.002.jpg
case_images: fig2
case_images: T1-weighted sequences that demonstrated a drop of signal on corresponding fat-suppressed T1-weighted sequences (Figures 2(a) and 2(b)). The soft-tissue component exhibited low and intermediate signal intensity on T1- and T2-weighted sequences (Figures 2(a)-2(d)), respectively, and avid gadolinium uptake (Figures 3(a) and 3(b)). T2-weighted sequences (Figures 2(c) and 2(d)). The bladder wall was diffusely thickened suggesting chronic outflow obstruction related to benign prostatic hypertrophy (Figures 1(a) and 2(c)).
case_images: 84-year-old male with presacral myelolipoma. Postcontrast T1-weighted fat-suppressed axial images at a higher (a) and lower (b) level of the mass demonstrated avid gadolinium uptake of the solid hematopoietic components of the lesion.
case_images: CRIM.RADIOLOGY2014-674365.003.jpg
case_images: PMC3933520_01_CRIM.RADIOLOGY2014-674365.003.jpg
case_images: fig3
case_images: T1-weighted sequences that demonstrated a drop of signal on corresponding fat-suppressed T1-weighted sequences (Figures 2(a) and 2(b)). The soft-tissue component exhibited low and intermediate signal intensity on T1- and T2-weighted sequences (Figures 2(a)-2(d)), respectively, and avid gadolinium uptake (Figures 3(a) and 3(b)).
case_images: 84-year-old male with presacral myelolipoma. Gross examination revealed a well-circumscribed, fleshy, and red-brown tumor, measuring 5,5 cm of greatest dimension. It was located in perirectal tissue, adjacent to the circumferential margin, and was 1 cm distant of the muscularis propria.
case_images: CRIM.RADIOLOGY2014-674365.004.jpg
case_images: PMC3933520_01_CRIM.RADIOLOGY2014-674365.004.jpg
case_images: fig4
case_images: On gross examination, a tumor with 5,5 x 4 x 3 cm of greatest dimensions was found in the perirectal adipose tissue (Figure 4).
case_images: 84-year-old male with presacral myelolipoma. Microscopic examination: the tumor was composed of varying amounts of mature adipose tissue admixed with hematopoietic elements ((a) and (b): H&E, x40); there were also dispersed hemorrhagic areas ((c): H&E, x40). In higher magnification view the presence of the three cell lineages (myeloid, erythroid, and megakaryocytic) was evident, similarly to the normal bone marrow ((d): H&E, x400).
case_images: CRIM.RADIOLOGY2014-674365.005.jpg
case_images: PMC3933520_01_CRIM.RADIOLOGY2014-674365.005.jpg
case_images: fig5
case_images: Histological examination of the resected specimen confirmed the diagnosis of myelolipoma (Figure 5).