Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2023; 11(18): 4377-4383
Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4377
Indium chloride bone marrow scintigraphy for hepatic myelolipoma: A case report
Akio Sato, Kazuhiro Saito, Koichiro Abe, Katsutoshi Sugimoto, Toshitaka Nagao, Aoi Sukeda, Daisuke Yunaiyama
Akio Sato, Kazuhiro Saito, Koichiro Abe, Daisuke Yunaiyama, Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan
Katsutoshi Sugimoto, Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan
Toshitaka Nagao, Aoi Sukeda, Department of Anatomic Pathology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan
Author contributions: Sato A designed the report; Sugimoto K collected the patient’s clinical data; Sato A, Saito K, Abe K, Nagao T, Sukeda A, and Yunaiyama D analyzed the data and wrote the paper; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akio Sato, MD, Doctor, Department of Radiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku 160-0023, Tokyo, Japan. sato.akio.8j@tokyo-med.ac.jp
Received: March 13, 2023
Peer-review started: March 13, 2023
First decision: April 19, 2023
Revised: May 2, 2023
Accepted: May 22, 2023
Article in press: May 22, 2023
Published online: June 26, 2023
Processing time: 105 Days and 13.8 Hours
Abstract
BACKGROUND

As hepatic myelolipoma is rarely encountered, its radiological diagnosis using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) is challenging. Hepatic myelolipoma is similar to fat-contained hepatic lesions seen in hepatocellular carcinoma and angiomyolipoma. Therefore, further development of techniques to diagnose hepatic myelolipoma is warranted.

CASE SUMMARY

A 44-year-old obese man was found to have a hepatic lesion during his medical checkup. The lesion was 50 mm × 57 mm in size and was detected in segment 8 (S8) of the liver by US. The patient was diagnosed with hepatic lesion 20 years ago, but it was left unresolved. The patient had no symptoms, liver dysfunction, hepatitis virus antibody, or tumor marker elevation. Plain CT showed a well-defined lesion in S8 of the liver. The central and peripheral areas of the lesion primarily exhibited fat density and hypodensity, respectively. MRI revealed a capsule-like structure. Biopsy was performed to address the probability of hepatocellular carcinoma. The lesion was pathologically confirmed as a myelolipoma. Bone marrow scintigraphy performed using 111InCl3 revealed accumulation of the radiopharmaceutical in the soft tissue component, except in the fat-dominant part of the tumor, as well as in the surrounding liver parenchyma due to the presence of reticuloendothelial cells in the liver.

CONCLUSION

This is the first report on the diagnosis of hepatic myelolipoma using 111InCl3 scintigraphy. The effectiveness of bone marrow scintigraphy for diagnosing hepatic myelolipoma might be limited. As radiopharmaceuticals accumulate in both hematopoietic and reticuloendothelial cells, the accumulation of radiopharmaceuticals in the lesion is obscure.

Keywords: Liver; 111InCl3; Myelolipoma; Magnetic resonance imaging; Benign tumor; Case report

Core Tip: We attempted to perform bone marrow scintigraphy for hepatic myelolipoma to determine whether 111InCl3 accumulates in the lesion. We found that the radiopharmaceutical accumulated in the soft tissue component, except for the fat-dominant part. However, the radiopharmaceutical also accumulated in the surrounding liver parenchyma, which comprised reticuloendothelial cells. Therefore, the effectiveness of bone marrow scintigraphy in diagnosing hepatic myelolipoma may be limited.