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The bone marrow component of adrenal myelolipoma shows normal trilineage hematopoiesis but with increased number of megakaryocytes. If only mature myeloid cells (granulocytes) are seen, it does not constitute the diagnosis of myelolipoma. Similarly, if a monomorphic population of immature myeloid cells is present, it may represent leukemic involvement within a lipoma. Recent experimental evidence suggests that the lipomatous component as well as the hematopoietic elements are derived from the same clone, suggesting that myelolipoma should be considered a true neoplasm.

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