Except for increase in weight and heaviness on the right side of the abdomen, the patient was asymptomatic
It all began when 55-year-old Ashwini Marwah, who had been steadily gaining weight over the last few years, considered getting a bariatric surgery. During investigations, the doctors an 11.5 kg adrenal tumour completely occupying the right side of the abdomen and also crossing over to the left side. They claim it is the world’s largest adrenal tumour.
The patient, who was suffering from type 2 diabetes mellitus (T2DM) and hypertension, had come in for evaluation for bariatric surgery. Anoop Mishra, the chairman of Fortis C-DOC, said: “During evaluation and investigations we found the abdominal tumour. The patient was unaware of the tumour. Except for increase in weight, a dragging sensation and heaviness on the right side of the abdomen, he was asymptomatic. The tumour was located adjacent to vital organs, particularly the kidney, inferior vena cava and intestines.”
The patient was shifted under the care of Randeep Wadhawan, the director of bariatric and gastrointestinal surgery at Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj. Dr. Wadhawan said: “The patient came in with a body mass index of 48, diabetes mellitus, hypertension and other medical complications. He was a high-risk candidate for the surgery.” Speaking about the surgery, Dr. Wadhawan added that the team had to make a large incision on the abdomen due to the size of the tumour. “On removal, the tumour weighed 11.5 kg. We believe this is the largest adrenal myelolipoma. It was also highly vascular and attached to the right kidney, inferior vena cava and intestines. The biggest challenge was to salvage the patient’s right kidney, since his kidney functions were already affected due to diabetes and hypertension. Histopathology of the tumour confirmed the diagnosis of adrenal myelolipoma, ” he added. The largest tumour reported in India so far weighed 6 kg and was removed in 2003, while the largest adrenal adenoma, the differential diagnosis for adrenal tumours, removed in the world weighed 7.5 kg and was removed in 2013, according to a release issued by the hospital.
Very rare benign tumour
Adrenal myelolipoma is a very rare benign tumour, which contains mature adipose tissue and variable amounts of haematopoietic elements. Most lesions are small and asymptomatic, and discovered incidentally. It is usually small, asymptomatic and non-functional in nature, with an overall incidence of 0.05% to 0.2%.