Abstract
Background: Regarding differential diagnosis of adrenal tumors, Myelolipoma must be kept in mind (as a cautionary tale) to avoid surgical exploration or extensive surgeries due to its non-functioning and benign nature.
Case Report: A 45-year-old male was referred for pain in the right lumber region. The patient had a history of hypertension since 7 years. On systemic examination, a mass was palpable in the right lumber region. Imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), revealed a well-defined mass with predominantly fatty content, likely a benign neoplastic lesion. Routine hematological and biochemical test results were within normal limits. The clinical diagnosis was pheochromocytoma, in view of the patient being known to have hypertension. To avoid rupture and retroperitoneal hemorrhage, right adrenalectomy was performed. Final histopathological diagnosis was made as giant adrenal myelolipoma.
Conclusions: Adrenal myelolipoma should be considered in the differential diagnosis of fat-containing tumors in the retroperitoneum. The uncommon presentation of this benign tumor sometimes causes confusion with other, aggressive neoplasms. CT and MRI are sensitive modalities of diagnosis, but confirmation of myelolipoma is based on histology; therefore care must be taken for accurate diagnosis to avoid extensive surgeries.

Keywords: Incidentilloma, Giant Myelolipoma, adrenal, imaging modalities