Abstract
BACKGROUND: Myelolipoma is a rare benign tumor composed of mature adipose and hematopoietic tissue, most commonly occurring in the adrenal glands. Thoracic myelolipoma is extremely uncommon, particularly when originating in the lung or chest wall, and is frequently misdiagnosed due to its nonspecific clinical and radiological features. This study aimed to retrospectively characterize the clinical, imaging, pathological, and surgical features of thoracic myelolipoma and to conduct a comprehensive literature review to improve understanding of this rare entity. METHODS: Thirteen cases of thoracic myelolipoma diagnosed at Tongji Hospital between October 2015 and January 2025 were retrospectively reviewed. Data collected included patient demographics, clinical presentation, imaging characteristics, surgical approach, histopathology, and outcomes. Additionally, a comprehensive literature review was conducted using PubMed, Web of Science, and the Cochrane Library, covering reports published from 1960 to 2025. Descriptive statistics were used for data analysis. RESULTS: Thirteen patients were included (mean age: 57.2 ± 8.0 years; 6 men). Nine patients (69.2%) presented with tumors in the posterior mediastinum, and four (30.8%) had tumors in the lung. Most lesions were well-circumscribed and incidentally detected. Eleven patients (84.6%) underwent uniportal video-assisted thoracoscopic surgery (VATS), and all cases were histopathologically confirmed as myelolipoma. No recurrence or metastasis was observed over a mean follow-up period of 40.5 ± 31.0 months. The literature review identified 71 additional cases with comparable clinical characteristics. Among the 33 patients with available follow-up, no recurrence or metastasis was reported. CONCLUSIONS: Thoracic myelolipoma is a rare, indolent tumor that is often discovered incidentally and is generally associated with a favorable prognosis following complete surgical resection. VATS represents a minimally invasive and effective approach, offering both diagnostic and therapeutic benefits. Conservative observation may be appropriate for asymptomatic patients with characteristic imaging findings. However, surgical intervention is recommended when clinical symptoms are present or malignancy cannot be ruled out. Further large-scale studies with extended follow-up are warranted to refine management strategies.