An Unusual Fat-Containing Presacral Tumor in an Elderly Patient

The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper. 1. Introduction Myelolipomas are benign tumors composed of both mature adipose and hematopoietic elements, most commonly occurring in the adrenal glands [1, 2]. This case report alerts to the possibility of presacral myelolipomas, which have been only occasionally reported in the literature but should nevertheless be considered in the differential diagnosis of every fat-containing tumor occurring in this region [3–10]. The imaging findings of these tumors completely overlap with those of their adrenal counterpart, as was observed in this case. Notwithstanding, other possible presacral tumors, such as teratomas and liposarcomas, may have similar CT and MRI appearance and therefore the definite diagnosis still requires histological confirmation [8–12]. 2. Case Report An 84-year-old male patient was admitted to our hospital with complaints of longstanding pelvic pain with more than six months of duration and significant worsening during the past month. He denied changes in bowel habits and urinary symptoms. The patient had a medical history of bladder cancer treated conservatively. Other medical problems included arterial hypertension and benign prostatic hypertrophy. Pelvic contrast-enhanced CT revealed a well-encapsulated and lobulated solid mass posterior to the rectosigmoid colon, measuring 5？cm in greatest dimension. 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)). Figure 1: 84-year-old male with