MR imaging to detect myelolipomas of the liver

Abstract Rationale: Primary hepatic myelolipoma is a rare benign neoplasm comprising mature adipose tissue and marrow components in various proportions. Chemical shift imaging (CSI) can distinguish the lipid within the tumor clearly; however, there have been no reports on the CSI of hepatic myelolipoma. Patient concern: A 20-year-old woman visited our hospital after discovering a space-occupying lesion in the liver with a history of more than 1 year. She felt distension pain and discomfort under the xiphoid process, accompanied by nausea, vomiting, and occasional chest oppression. Diagnosis: The tumor showed a well-defined mass with a pseudocapsule and a heterogeneous appearance on both T1- and T2-weighted magnetic resonance (MR) images. CSI analysis showed a signal decline within the tumor. Based on the histopathology, the tumor was diagnosed as hepatic myelolipoma. Interventions and Outcomes: The patient underwent a right hepatectomy, and the postoperative vital signs were stable. Two weeks later, the patient was discharged safely. Lessons: Although hepatic myelolipoma is extremely rare, this condition should be considered in differential diagnosis when CSI shows that hepatic lesions contain fatty.