ABSTRACT
INTRODUCTION AND IMPORTANCE: Adrenal Lipoma (LA) is a benign very rare tumor that accounts for 0.7 % of primary adrenal tumors and 4 % of adrenal fatty tumors. They are asymptomatic and discovered accidentally by a CT scan or the US. CASE PRESENTATION: This case report describes an incidentally discovered giant adrenal lipoma in a 45-year-old Asian woman with no prior medical history, presenting with episodic blood pressure fluctuations and abdominal pain attributed to coexisting gallstones. Imaging revealed a heterogeneous, well-demarcated adrenal mass measuring 17 × 14 × 11 cm with a 2 × 3 cm nodular density. Histopathological examination confirmed a 15 cm lipoma with ischemic changes, devoid of atypical features. This case underscores the importance of thorough investigation for adrenal masses, even in asymptomatic individuals. DISCUSSION: This case report details a rare instance of a giant adrenal lipoma (17 × 14 × 11 cm, 870 g) co-occurring with gallstones in a 45-year-old woman experiencing chronic abdominal pain. Computed tomography revealed a characteristic homogenous fatty lesion, prompting open surgical resection due to the tumor's size. Hormonal evaluation confirmed a non-functioning tumor. This case emphasizes the challenges in diagnosing and managing giant adrenal lipomas, advocating for comprehensive investigation of adrenal masses, particularly with concurrent hypertension. CONCLUSION: Giant adrenal lipomas (LAs) are rare, benign tumors often presenting asymptomatically. This report documents the fifth largest and third heaviest LA reported, notably co-occurring with gallstones. While laparoscopic resection is ideal, delayed diagnosis due to insidious presentation can lead to increased tumor size, potentially precluding minimally invasive approaches.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Giant bladder stones, exceeding 100 g, are rare and typically affect males. This report describes an atypical case of a 35-year-old female with a 560-g bladder stone causing acute kidney injury without evidence of upper urinary tract stones. CASE PRESENTATION: A 35-year-old female presented with pelvic pain and urinary retention. Comprehensive imaging, including a KUB x-ray and subsequent ultrasound, revealed a giant bladder stone obstructing the ureters and causing bilateral hydronephrosis. Urinalysis showed a severe urinary tract infection. Given the stone's significant size and its firm attachment to the bladder wall, open cystolithotomy was performed. The patient recovered well and was subsequently discharged without postoperative complications. CLINICAL DISCUSSION: Giant bladder stones are rare in young females. This case highlights the uncommon presentation of a 560-g stone in a female, causing acute kidney injury while there were no upper tract stones detected. The role of urinary tract infection as a contributing factor is explored, although other etiological factors are also considered. CONCLUSION: Open cystolithotomy proved to be an effective treatment. Postoperative recommendations included dietary modifications to minimize the risk of recurrence. This case expands our knowledge of giant bladder stones in this population.
