adrenal myelolipoma is a tumor - like lesion composed of variable amounts of mature adipose tissue and bone marrow elements . in spite of wbc and rbc precursors such as megakaryocytes
giercke in 1905 first described and 24 years later , oberling coined the term  myelolipoma.
only two cases under the age of 16 are reported and to the best of our knowledge , this patient is the youngest pediatric case of adrenal myelolipoma reported in the english literature .
an 11-year - old girl presented with recurrent pain abdomen for 1 year , which was gradually increasing in frequency and severity for last 5 months .
ultrasonography ( usg ) of abdomen showed a well - encapsulated and hypo echoic lesion in right suprarenal region measuring 27.1  24.3 mm .
contrast enhanced computed tomography ( cect ) scan of abdomen confirmed the lesion to be arising from right adrenal gland with fat density measuring 1.8  2.3 cm [ figure 1 ] .
gross examination of the specimen showed reddish yellow colored friable mass , soft in consistency ; and on microscopy , islands of hematopoietic tissue were found scattered among the fat cells [ figure 2 ] .
cect reveal small fat containing lesion in right adrenal suggestive of myelolipoma histopathology showing fat lobules ( f ) and megakaryocyte ( m )
adrenal myelolipoma is a tumor - like lesion composed of variable amounts of mature adipose tissue and bone marrow elements . in spite of wbc and rbc precursors such as megakaryocytes
myelolipoma may occur in retroperitoneum around kidney and pre - sacral space or in liver ; however , adrenal gland is the most common site .
most of the cases of myelolipomas are asymptomatic . usually diagnosed incidentally at imaging for other purposes and the reported incidence are reaching up to 7% of the adrenal masses .
majority of incidentally discovered myelolipomas are small and asymptomatic though large symptomatic lesions are also reported but in adult population .
symptoms may be due to large tumor causing the pressure effect , tumor necrosis and intralesional hemorrhage .
malignant potential of adrenal myelolipoma has not been reported . in our study , the child presented with pain abdomen and , on investigation diagnosis was confirmed .
the lesion is itself hormonally inactive but may be associated with metabolically active adrenal lesion like cushing syndrome , conn 's syndrome , congenital adrenal hyperplasia etc .
myelolipoma can be regarded as an exception to the mandatory metabolic work - up of a newly discovered adrenal mass .
large myelolipoma usually associated with hematological disorders like hereditary spherocytosis , thalassemia intermedia , thalassemia major , sickle cell anemia and usually bilateral
if we get a case of large or bilateral adrenal myelolipoma we have to investigate for chronic hematological disorders . before removal
the of tumor , it may be necessary for bone marrow transplantation to avoid aggravation of hemolytic anemia .
most accepted theory regarding etiologies are that it arises in response to infection , stress or necrosis causing metaplasia of reticuloendothelial cells of the capillaries of adrenal gland .
focal fat density , peripheral calcification and hemorrhage within the tumor can be better identified with cect scan .
myelolipoma contains adipocytes with hematopoietic elements , consisting of myeloid and erthyroid precursors , as well as , megakaryocytes .
these hematopoietic elements are scattered in the adrenal tissue and separated by sheets and large clusters of mature adipocytes admixed with hemorrhagic foci .
though open surgery is the classical method , laparoscopic adrenalectomy has now become the standard of care for the treatment of functioning and non - functioning adrenal tumors , introduced by gagner in 1992 .
small asymptomatic myelolipomas can be treated conservatively but the symptomatic one should be treated with surgical excision and/or adrenalectomy .
 myelolipoma is a rare benign tumor of adrenal gland and rarer in children . 
 myelolipoma contains adipose tissue and myeloid precursor producing white blood cells ( wbc ) , red blood cells ( rbc ) and megakaryocytes . 
 asymptomatic tumor does not require treatment whereas symptomatic tumor needs operation . 
 we are reporting a rare adrenal myelolipoma in a child with review of literature . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION