Report of a case: Retroperitoneal mucinous cystadenocarcinoma with rapid progression

Primary Retroperitoneal Mucinous Cystadenocarcinoma during Long-term Administration of Infliximab for the Treatment of Crohn's Disease

We herein report a rare case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC) in a 60-year-old man. The patient, who had been treated with infliximab for Crohn's disease of the colon for 13 years, was referred to our hospital for lower back pain. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging revealed multiple cystic lesions in the right retroperitoneum, the calcification of the cyst, and bone lesions. Bone and CT-assisted biopsies of the retroperitoneal lesions revealed poorly differentiated adenocarcinoma. The patient was diagnosed with PRMC with bone metastases using immunohistochemical staining and positron emission tomography/CT.

Primary Retroperitoneal Mucinous Cystadenocarcinoma: A Case Report

Mucinous neoplasms are commonly seen in the ovaries and pancreas. Their occurrence in the retroperitoneum is uncommon. We present a case of a retroperitoneal mucinous cystadenocarcinoma in a 54-year-old female who presented with right flank pain. Imaging demonstrated an 8.6 × 7.9 cm mass at the anterior surface of the lower pole of the right kidney, suspicious for renal cell carcinoma. Serum tumor markers carbohydrate antigen 19-9 (CA 19-9) and cancer embryonic antigen (CEA) were within normal limits, and cancer antigen 125 (CA 125) was elevated. Surgical resection of the mass was performed. Intraoperatively, the mass was noted to lie in the retroperitoneum, unattached to the kidney. On gross examination, a 10.0 × 7.0 × 7.0 cm unilocular cystic structure with red-brown mucoid material was present. The inner lining was mostly smooth with areas of excrescences, covering less than 5% of the surface area. Microscopic examination showed cystic areas lined by mucinous epithelium with an underlying ovarian-type stroma. Solid areas showed features of a borderline papillary mucinous tumor with invasive carcinoma. A diagnosis of mucinous cystadenocarcinoma was made. Their occurrence in the retroperitoneum is unusual. Although rare, this entity should always be considered in the differential diagnosis of retroperitoneal cystic lesions.

Retroperitoneal primary adenocarcinoma of Mullerian origin: case report with radiology review

Retroperitoneum Mullerian neoplasms are extremely rare malignancies. We report a case of a 35-year-old woman who presented with a 12-year history of lower abdominal cystic lesion, presumed of renal origin and benign, as such was not followed for 10 years. Prior to pregnancy, the patient received additional imaging and the lesion was again redemonstrated and questioned to be of ovarian origin. As such, the patient underwent laparoscopy for planned cystectomy and was found to have normal ovaries. After pregnancy, the lesion had increased in size and surgical excision revealed that the cystic mass was retroperitoneal in origin. The histopathology was reported as microinvasive mucinous adenocarcinoma with Mullerian origin. Positron emission tomographic scanning, colonoscopy, and endoscopy were unrevealing. Tumor markers were followed and follow-up scans demonstrated no recurrence.

The preoperative diagnosis of primary retroperitoneal adenocarcinomas of Mullerian origin is difficult, and a definitive diagnosis cannot be made without postsurgical histopathological analysis. However, it is important for radiologists to recognize imaging features of this entity and include it in the differential diagnosis. Here we report a case and review imaging features reported for retroperitoneal primary adenocarcinomas of Mullerian origin.

Mucinous cystadenocarcinoma in the renal pelvis: primary or secondary? Case report and literature review

INTRODUCTION

Cystic lesions in the renal pelvis may cause a diagnostic dilemma. These lesions may be benign or (pre)malignant and primary of secondary.

CASE REPORT

A 65-year-old woman presents with a complex cystic mass in the lower pole of the left kidney measuring approximately 16 cm in size and classified as Bosniak type 2F with minimally thickened septa and thick calcifications on non-contrast-enhanced computed tomography. The histopathological findings are consistent with a mucinous cystadenocarcinoma in the renal pelvis. Given the absence of a primary focus and based on clinical and radiological examination, the diagnosis of a primary renal neoplasm is preferred.

DISCUSSION

A review of the literature is performed to evaluate the histological differential diagnosis and confirm the diagnosis. Epidemiology with an overview of available similar cases since 2009, as well as etiological factors, treatment and prognosis was reviewed.

CONCLUSION

Primary renal mucinous cystadenocarcinoma is an exceedingly rare tumor. Histopathology still remains the gold standard for the diagnosis of this tumor. Because of the rarity, secondary involvement from more common sites, such as ovary and gastrointestinal tract, should be thoroughly excluded.

Primary retroperitoneal mucinous cystadenocarcinoma with transition from the mesothelium

INTRODUCTION

Mucinous cystic neoplasms are uncommon among the tumors that develop in the retroperitoneum. We report a case of primary retroperitoneal mucinous cystadenocarcinoma with pathological considerations.

CASE PRESENTATION

A 47-year-old woman complaining of abdominal discomfort presented at our hospital. Abdominal computed tomography and magnetic resonance imaging showed a large cystic tumor with small solid nodules located in the right retroperitoneum. The tumor was completely removed and the microscopic findings were consistent with primary retroperitoneal mucinous cystadenocarcinoma. Two years after the surgery, the patient is alive without recurrence of the tumor.

CONCLUSION

The microscopic findings suggested that the primary retroperitoneal mucinous cystadenocarcinoma developed from the metaplasia of the remnant coelomic epithelium. A complete tumor resection that includes the adjacent peritoneum is important to prevent local recurrence.

Management of Primary Retroperitoneal Mucinous Tumors: A Retrospective Meta-Analysis

OBJECTIVE

Primary retroperitoneal mucinous tumors (PRMTs) are rare epithelial neoplasms arising in the retroperitoneal space whose pathogenesis is poorly understood. To date, only single-case reports and small case series on diagnosis and management of these tumors exist. The aim of this first-time meta-analysis was to provide more reliable data to inform the management of PRMTs.

METHODS

Database searches were conducted to identify case reports and case series between the years of 1975 and 2015. Two cases of patients treated at our institution were also included. Diagnostic, radiographic, surgical, and follow-up data were gathered. Regression modeling was used to identify factors aiding preoperative diagnosis and affecting treatment. Survival analysis including Cox regression modeling was performed to provide insights into treatment effects on the prognosis of female patients with PRMTs.

RESULTS

One hundred forty-four cases of PRMTs were included in this analysis. Eighty-nine percent occurred in women. Most of the PRMTs were found to be malignant (53%). No preoperative factors predicting tumor dignity were identified by multiple regression analysis. Five-year disease specific survival of patients with benign and borderline tumors was excellent, reaching 100%, whereas it was only 68% for patients with malignant disease. Adjuvant surgical treatments including hysterectomy, salpingoophorectomy, and lymph node dissection were not associated with a statistically significant survival advantage. However, there was a nonsignificant association of hysterectomy with improved survival (hazard ratio, 0.42; 95% confidence interval, 0.09-2.07; P = 0.285). Adjuvant chemotherapy was associated with reduced survival (hazard ratio 3.791; 95% confidence interval, 1.509-9.526; P = 0.0046).

CONCLUSIONS

A reliable diagnosis of a PRMT can only be made by pathological examination of the tumor. Surgical excision is thus necessary to facilitate diagnosis while it also remains the mainstay of treatment. There is no conclusive evidence supporting the role of adjuvant surgical procedures or chemotherapy.

The long-term survival in primary retroperitoneal mucinous cystadenocarcinoma: a case report

Background

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is extremely rare, and its biological behavior, pathogenesis, optimum treatments, and prognosis remain to be elucidated. We herein report a case of PRMC with an 80-month follow-up.

Case presentation

A 29-year-old woman was diagnosed with unknown retroperitoneal tumor with benign right ovarian cyst and uterine fibroids, and she underwent laparotomy. The tumor was completely resected with a subsequent histopathological diagnosis of primary retroperitoneal mucinous cystadenocarcinoma (PRMC). Eighty months after surgery, she remains recurrence-free.

Conclusion

PRMC is an extremely rare tumor. Only around 60 cases have so far been published in the literature. The preoperative diagnosis of PRMC is difficult, and a definitive diagnosis can usually only be made based on the findings of histopathological examinations after surgery. Presently, only radical resection is useful for both diagnostic and therapeutic purposes. The optimal long-term management after surgery is still not well established. Further studies on PRMC are therefore needed to elucidate the etiology and establish effective treatments.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMCa): a systematic review of the literature and meta-analysis

PURPOSE

Primary retroperitoneal mucinous cystadenocarcinoma (PRMCa) is a rare tumour. Prognosis and optimal management are not well established. In view of a case managed in our Centre, we performed a systematic review and meta-analysis.

METHOD

Systematic review of medical electronic databases for published data (1950-12/10/2015). No RCTs identified. Individual patient data detracted from case reports and case series were analysed

RESULTS

In total, 73 female and 5 male cases of PRMCa identified including our case. Median age at diagnosis was 42.0 years (range 18-86 years), with women being significantly younger than men at diagnosis (42.0 years versus 62.2 years, p = 0.005). A palpable abdominal mass and abdominal pain were the most common presentations in 42.9 and 23.8 % of cases, respectively. Twenty-six women were <38 years old. There were 16 women <38 years old that had surgical data reported, of which 14 underwent fertility-sparing surgery with excision of the mass. Adjuvant chemotherapy was given in 24.1 % (13/72) women. Follow-up ranged from 1 to 130 months with a median of 15 months. Of the 57 cases that had follow-up reported, recurrence occurred in 23 cases (40.4 %) within a median of 8 months from diagnosis. Median disease-free survival was 15 months (range 1-130 months). Of the women who recurred, 14 died of their disease giving 1, 2 and 5-year disease-specific survival rates of 85.9, 80.7 and 75.4 %, respectively.

CONCLUSION

PRMCa are rare and potentially aggressive tumours that often occur in young women. Removal of the tumour, adequate staging and adjuvant chemotherapy needs to be considered.