2017 Volume 50 Issue 2 Pages 158-165
We treated a patient with early gastric cancer with a very rare presacral myelolipoma. This rare lesion was found incidentally as a fat containing 4 cm tumor in the presacral space during preoperative examinations for the gastric cancer. This lesion was considered suspicious as a liposarcoma according to CT and MRI images. Therefore the presacral tumor was widely excised in order to obtain tumor specimens and diagnose it histologically. It was not difficult to excise it, because it was encapsulated and not invasive to surrounding tissues. The presacral tumor was finally diagnosed as myelolipoma based on pathological findings which were composed of mature adipose tissue and hematopoietic elements. This diagnosis of the tumor allowed us to perform a complete resection for the gastric cancer. Presacral myelolipoma is a benign but very rare fat-containing tumor, which should be discriminated from the liposarcoma occasionally arising in the retroperitoneum. However, it is too difficult to discriminate between these two lesions under only conventional CT or MRI imaging and the difficulty led us to obtain tumor specimens by fine needle aspiration biopsy or tumor resection. In this case, a PET-CT image was taken as a pretreatment examination. We suggest that this image can be effective for differential diagnosis, because maximal standardized uptake value (SUV) in this case was 1.61 and lower than that in liposarcoma cases previously reported. This new device is promising and may help to discriminate between presacral fat containing tumors.
