1
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Montanarella M, Gonzalez Baerga CI, Menendez Santos MJ, Elsherif S, Boldig K, Kumar S, Virarkar M, Gopireddy DR. Retroperitoneal anatomy with the aid of pathologic fluid: An imaging pictorial review. J Clin Imaging Sci 2023; 13:36. [PMID: 38205277 PMCID: PMC10778072 DOI: 10.25259/jcis_79_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024] Open
Abstract
The retroperitoneum, a complex anatomical space within the abdominopelvic region, encompasses various vital abdominal organs. It is compartmentalized by fascial planes and contains potential spaces critical in multiple disease processes, including inflammatory effusions, hematomas, and neoplastic conditions. A comprehensive understanding of the retroperitoneum and its potential spaces is essential for radiologists in identifying and accurately describing the extent of abdominopelvic disease. This pictorial review aims to describe the anatomy of the retroperitoneum while discussing commonly encountered pathologies within this region. Through a collection of illustrative images, this review will provide radiologists with valuable insights into the retroperitoneum, facilitating their diagnostic proficiency to aid in appropriate patient clinical management.
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Affiliation(s)
- Matthew Montanarella
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | | | | | - Sherif Elsherif
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Kimberly Boldig
- Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Sidhu Kumar
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
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2
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Shen W, Geng H, Zhou Y, Yang X. Pediatric retroperitoneal non-organ-originated malignancies: An analysis based on SEER database. Medicine (Baltimore) 2023; 102:e34910. [PMID: 37800819 PMCID: PMC10553003 DOI: 10.1097/md.0000000000034910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 10/07/2023] Open
Abstract
Retroperitoneal non-organ-originated malignancies are rare pediatric tumors with challenging diagnosis and treatment. The present study aimed to analyze the clinicopathological characteristics, treatment, and prognosis of retroperitoneal non-organ-originated malignancies. In the study, we included the pathological diagnosis of pediatric retroperitoneal non-organ-originated malignant tumors between 2000 to 2019 through the updated Surveillance, Epidemiology, and End Results database. We use the Kaplan-Meier survival curve to calculate the overall survival (OS) and cancer-specific survival (CSS). The risk of all-cause death and disease-specific death were analyzed using Cox proportional hazard regression model and Fine-and-Grey competitive hazard model, respectively. In the study, a total of 443 pediatric retroperitoneal non-organ-originated malignancies were included. Of them, only 22.3% of patients had no metastatic disease, 42.9% had distant metastasis and 34.8% had locally advanced diseases. The primary pathological tumor was neuroblastoma followed by germ cell tumor. The overall 10-year OS and CSS were 70.7% and 73.1%, respectively, and the 10-year OS and CSS of metastatic diseases were 54.4% and 56.6%, respectively. Older children, worse tumor stage at diagnosis, incomplete resection, and prolonged time from diagnosis to treatment were significantly associated with worse survival outcomes. Radiotherapy and chemotherapy did not significantly improve the prognosis of patients without complete tumor resection. The study indicated that most pediatric retroperitoneal non-organ-originated malignancies diagnosed with metastatic diseases have plagued treatment. Radiotherapy and chemotherapy are the main treatment methods for children unable to undergo complete surgical treatment. However, these treatments do not reach the same therapeutic effect as complete tumor resection after early diagnosis. Hence, early diagnosis and surgery for complete tumor resection are of utmost importance.
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Affiliation(s)
- Wei Shen
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Hongqiong Geng
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Yin Zhou
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Xinghai Yang
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
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3
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Guo Q, Zhao J, Du X, Hu H, Huang B. Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study. Int J Surg 2023; 109:2689-2695. [PMID: 37578462 PMCID: PMC10498861 DOI: 10.1097/js9.0000000000000429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication; however, the incidence and risk stratification of postoperative VTE in patients with retroperitoneal tumor remains unclear. The authors aim to quantify the incidence, identify risk factors, and determine the outcomes of VTE in patients undergoing retroperitoneal tumor surgery. METHODS The authors retrospectively reviewed the characteristics, perioperative outcomes, and overall survival (OS) of patients (VTE and non-VTE) who underwent retroperitoneal tumor surgery between 2015 and 2020. Perioperative and oncologic outcomes were compared using propensity-matching and Cox analyses. RESULTS Of 1223 patients with retroperitoneal tumor surgery, 2.1% had VTE. Age [odds ratio (OR) 1.140, 95% CI: 1.053-1.239, P =0.004], recurrence (OR 1.851, 95% CI: 1.241-2.761, P =0.003), and vascular resection (OR 2.036, 95% CI: 1.054-3.934, P =0.034) were independent risk factors, with significant between-group differences regarding age, recurrence, sarcoma, organ resection, vascular resection, and operation time. No between-group differences in 30-day all-cause mortality (8 vs. 4%, OR 0.657, 95% CI: 0.375-1.151, P =0.427) and major complications (12 vs. 8%, OR 0.775, 95% CI: 0.483-1.244, P =0.572) were observed. Mean hospitalization duration (20.1 vs. 22.9 days, OR 1.153, 95% CI: 1.022-1.386, P =0.033) and ICU stay (3.2 vs. 5.5 days, OR 1.193, 95% CI: 1.034-1.347, P =0.012) were shorter in non-VTE versus VTE, respectively, with inferior OS (hazard ratio 2.090, 95% CI: 1.014-4.308, P =0.046) in VTE. CONCLUSIONS Age, recurrence, and vascular resection are positively associated with VTE, which is associated with inferior OS.
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Affiliation(s)
| | | | | | | | - Bin Huang
- Department of General Surgery, Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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4
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Gonzales R, De Robles MS, Winn R. Pneumoretroperitoneum - is it always an ominous sign? ANZ J Surg 2022; 93:1040-1041. [PMID: 36222827 DOI: 10.1111/ans.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Raphael Gonzales
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
| | - Marie Shella De Robles
- Department of Surgery, Wollongong Hospital, Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Keiraville, Australia.,Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Robert Winn
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
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5
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Huynh AD, Sweet DE, Feldman MK, Remer EM. Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies. Br J Radiol 2022; 95:20211151. [PMID: 35762317 PMCID: PMC10996964 DOI: 10.1259/bjr.20211151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/19/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
Diagnostic imaging allows for accurate and early recognition of acute renal pathologies, thus allowing for appropriate clinical triage, life-saving treatments, and preservation of renal function. In this review, we discuss the clinical presentation and imaging findings of renal emergencies with infectious, hemorrhagic, vascular, and traumatic etiologies.
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Affiliation(s)
- Alan D. Huynh
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - David E. Sweet
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Myra K Feldman
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Erick M Remer
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
- Glickman Urological and Kidney Institute, Cleveland
Clinic, Cleveland, United
States
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6
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Gulati V, Swarup MS, Kumar J. Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach. Indian J Radiol Imaging 2022; 32:235-252. [PMID: 35924125 PMCID: PMC9340194 DOI: 10.1055/s-0042-1744142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.
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Affiliation(s)
- Vaibhav Gulati
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - M. Sarthak Swarup
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Jyoti Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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7
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Verma N, Steigner ML, Aghayev A, Azene EM, Chong ST, Desjardins B, El Khouli RH, Harrison NE, Hedgire SS, Kalva SP, Lee YJ, Mauro DM, Mehta HJ, Meissner M, Pillai AK, Singh N, Suranyi PS, Williamson EE, Dill KE. ACR Appropriateness Criteria® Suspected Retroperitoneal Bleed. J Am Coll Radiol 2021; 18:S482-S487. [PMID: 34794602 DOI: 10.1016/j.jacr.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
The initial diagnosis of retroperitoneal bleeding can be challenging by physical examination and clinical presentation. Prompt imaging can make the diagnosis and be lifesaving. When selecting appropriate imaging for these patient's, consideration must be made for sensitivity and ability to image the retroperitoneum, as well as speed of imaging.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Nupur Verma
- Program Director, Radiology, University of Florida, Gainesville, Florida.
| | - Michael L Steigner
- Panel Chair; and Director, Vascular CT/MR, and Medical Director, 3D Lab, Brigham & Women's Hospital, Boston, Massachusetts
| | - Ayaz Aghayev
- Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Suzanne T Chong
- Indiana University, Indianapolis, Indiana; and Chair, ER Committee, ACR GSER Commission
| | | | - Riham H El Khouli
- Director, Theranostic Program and Chair, NM&MI Clinical Protocol and Quality Improvement (CPQI) Committee, University of Kentucky, Lexington, Kentucky
| | - Nicholas E Harrison
- Wayne State University, Detroit, Michigan; American College of Emergency Physicians
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjeeva P Kalva
- Chief, Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts; International Editor, Journal of Clinical Interventional Radiology ISVIR; and Assistant Editor, Radiology - Cardiothoracic, RSNA
| | - Yoo Jin Lee
- University of Virginia Medical Center, Charlottesville, Virginia
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hiren J Mehta
- University of Florida College of Medicine, Gainesville, Florida; Primary care physician - critical care
| | - Mark Meissner
- University of Washington School of Medicine, Seattle, Washington; President, American Vein & Lymphatic Society; At-Large Board Member, Intersocietal Accreditation Commission; General Secretary, International Union of Phlebology; and Society for Vascular Surgery
| | - Anil K Pillai
- Section Chief, UT Southwestern Medical Center, Dallas, Texas
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | - Eric E Williamson
- Mayo Clinic, Rochester, Minnesota; Society of Cardiovascular Computed Tomography
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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8
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Tseng H, Wang AL, Lin HT, Lee CC, Chen WC. Entire Bilateral Kidneys Enhanced by Air Contrast after Ventilation-induced Alveolar Rupture. Am J Respir Crit Care Med 2021; 203:e31-e32. [PMID: 33412081 DOI: 10.1164/rccm.202006-2447im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Chi Chan Lee
- Department of Critical Care, Oregon Health and Science University Hospital, Portland, Oregon; and
| | - Wei-Cheng Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.,Department of Education, China Medical University Hospital, Taichung, Taiwan
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9
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Zhang QW, Song T, Yang PP, Hao Q. Retroperitoneum ganglioneuroma: imaging features and surgical outcomes of 35 cases at a Chinese Institution. BMC Med Imaging 2021; 21:114. [PMID: 34294064 PMCID: PMC8296746 DOI: 10.1186/s12880-021-00643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background The preoperative evaluation is crucial for diagnosis and surgical plan of retroperitoneum ganglioneuroma (GN). In this study, we reviewed a relatively large series of histopathological proved retroperitoneum GN cases, summarized the imaging features and further depicted risk factors of increased surgical blood loss. Methods A total of 35 (18 male, 17 female) patients were retrospectively enrolled from January 2012 to June 2019 at our institution. Among them, 24 patients had undergone CT scans and 19 patients had undergone MR examination before treatment. The clinical and radiological features were analyzed and the relationships between image features and surgical blood loss were evaluated. Results The media age of the involved 35 patients was 40 years (range, 14–66 years). The histological tumor size was 10.12 ± 4.56 cm for average. Retroperitoneum GN was relatively low density on unenhanced CT images and showed delayed progressive enhancement on enhanced CT and MR images. The whorled sign could be seen in 14 patients. The vessel encasement sign could be found in 17 patients. Univariate analysis revealed maximal tumor size measured on axial image, maximal tumor size measured on coronal image, encasing one or both renal pedicles, encasing the aorta and/or vena cava and whorled sign on MRI showed significant difference between the blood loss ≥ 400 ml and blood loss < 400 ml group. Logistic regression further detected that maximal tumor size measured on axial images (OR: 1.12; 95% CI: 1.02–1.24; P = 0.023) and encasing one or both renal pedicles (OR: 22.39; 95% CI: 1.35–372.99; P = 0.030) were independently correlated with surgical blood loss. Conclusions Preoperative CT and MR imaging analysis was valuable for both diagnosis and surgical risk prediction of retroperitoneum GN.
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Affiliation(s)
- Qian-Wen Zhang
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Tao Song
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Pan-Pan Yang
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China.
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10
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Al-Dasuqi K, Irshaid L, Mathur M. Radiologic-Pathologic Correlation of Primary Retroperitoneal Neoplasms. Radiographics 2021; 40:1631-1657. [PMID: 33001785 DOI: 10.1148/rg.2020200015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An earlier incorrect version of this article appeared in print. The online version is correct.
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Affiliation(s)
- Khalid Al-Dasuqi
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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11
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Effects of Manual Therapy on the Diaphragm in the Musculoskeletal System: A Systematic Review. Arch Phys Med Rehabil 2021; 102:2402-2415. [PMID: 33932362 DOI: 10.1016/j.apmr.2021.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 03/23/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults. DATA SOURCES Systematic review using 4 databases: PubMed, Science Direct, Web of Science, and Scopus. STUDY SELECTION AND DATA EXTRACTION Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review. DATA SYNTHESIS Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain. CONCLUSION Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal, and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long-term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.
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12
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Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know. Abdom Radiol (NY) 2021; 46:1062-1081. [PMID: 32944824 DOI: 10.1007/s00261-020-02752-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis.
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13
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Ding W, Xu X, Duan Y, Qu Z, Chen J, Sun D, Lu Y. Minimally Invasive Surgery of Primary Retroperitoneal Tumors from the Perspective of General Surgeons: 6 Years of Experience at a Single Institution. J Laparoendosc Adv Surg Tech A 2020; 31:698-704. [PMID: 32931358 DOI: 10.1089/lap.2020.0603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: This retrospective study aimed to present our surgical experience in patients with primary retroperitoneal tumors (PRTs) who underwent laparoscopic surgery and to compare the results with those of patients who underwent an open operation. Materials and Methods: We analyzed the medical data of patients who underwent retroperitoneal tumor resection through laparoscopic surgery or open operation between February 2014 and November 2019. Results: In total, 77 patients were enrolled. In total, 37 patients underwent open surgery and 40 patients underwent laparoscopic surgery. The tumor size in the open surgery group (10.2 ± 5.4 cm) was more significant than that in the laparoscopic surgery group (6.5 ± 3.1 cm) (P < .001). No difference was observed in operative time, blood loss, and transfusion between the two groups. Postoperative hospitalization in the open group (8.43 ± 2.77 days) was longer than that in the laparoscopic group (5.63 ± 2.16 days) (P < .001). The patients with PRTs in the IV area had minimal bleeding (16.67 ± 40.82 mL) and minimum postoperative hospitalization (3.83 ± 1.60 days). Conclusions: Laparoscopic resection of PRT is feasible in the selection of appropriate cases. The advantages are small trauma, light pain, quick recovery, and short hospital stay. It is especially suitable for benign PRTs with small size and cystic or small adhesion with vital organs or great vessels.
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Affiliation(s)
- Wei Ding
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China.,Department of General Surgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
| | - Xuezhong Xu
- Department of General Surgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
| | - Yunfei Duan
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Zhen Qu
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Jing Chen
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Donglin Sun
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Yunjie Lu
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
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14
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Sassa N. Retroperitoneal tumors: Review of diagnosis and management. Int J Urol 2020; 27:1058-1070. [PMID: 32914475 DOI: 10.1111/iju.14361] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022]
Abstract
Retroperitoneal tumors are extremely rare tumors occurring in the retroperitoneum. Retroperitoneal tumors are divided into benign tumors and malignant tumors, including retroperitoneal sarcoma. Approximately 70-80% of primary retroperitoneal soft-tissue tumors are malignant; however, these only account for 0.1-0.2% of all malignancies. Retroperitoneal sarcoma is an orphan malignant disease with a low incidence. The information on benign retroperitoneal tumors is limited. The American Joint Committee on Cancer/TNM classification updated to the 8th edition in 2017. In 2010, three new drugs for soft tissue sarcoma were approved based on the results of phase III trials, but the histological subtypes of the patients enrolled in the trials of each drug differed. Recently, in addition to surgery for retroperitoneal sarcoma, the effectiveness of perioperative radiation therapy has become interesting. For malignant retroperitoneal tumors and retroperitoneal sarcoma, survival improvement and locoregional recurrence prevention can be undertaken by carrying out surgery to secure negative margins with wide and combined resection of some adjacent organs, and cooperation with a trained medical team comprising of radiologists, pathologists and medical oncologists in centralized hospitals. Some clinical trials aimed at further improving treatment results by adding preoperative chemotherapy and radiation therapy based on histological confirmation using a correct needle biopsy are in progress. In recent years, molecular profiling has been used to select eligible patients for chemotherapy. In the future, precision medicine with next-generation sequencing technology will be expected among the diverse and potential future treatments for retroperitoneal sarcoma. In this review, we summarized the current state of retroperitoneal tumors and retroperitoneal sarcoma.
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Affiliation(s)
- Naoto Sassa
- Department of Urology, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan
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15
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Abstract
RATIONALE Primary retroperitoneal germ cell tumors are uncommon and especially rare in female patients. However, this type should be included in the differential diagnosis of retroperitoneal tumors that may metastasize from the gonads and be a primary tumor. PATIENT CONCERNS An abdominal mass was detected in a 38-year-old woman during physical examination, which was accompanied by left renal obstructive hydrops. She was admitted to our institution for further investigation. The patient had no obvious clinical symptoms, and the levels of serum tumor markers did not signifificantly increase. Abdominal noncontrast enhanced and contrast-enhanced computed tomography revealed a retroperitoneal neoplasm that invaded the left ureter, thereby causing left hydronephrosis. DIAGNOSES Imaging examination characterized the tumor as malignant based on its invasion in the left ureter. Histopathology and immunohistochemistry confifirmed the resected tumor as a dysgerminoma. The primary gonad-derived germ cell tumor was not found in the pelvis; therefore, the patient was fifinally diagnosed with primary retroperitoneal germ cell tumor. INTERVENTIONS Preoperative examination was completed, and the retroperitoneal mass was resected. OUTCOMES During the short-term follow-up, no tumor recurrence was detected. LESSONS Primary retroperitoneal seminoma should be included in the differential diagnosis of primary retroperitoneal tumors in female patients. The primary retroperitoneal seminoma/anaplastic tumor has an obvious occupying effect and can easily invade the surrounding structures. However, surgical resection of such tumors is an optional treatment strategy.
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Affiliation(s)
- Qitian Lou
- Department of Radiology, Ninghai First Hospital, Ninghai, Ningbo, Zhejiang
| | - Weigen Wang
- Department of Radiology, Ninghai First Hospital, Ninghai, Ningbo, Zhejiang
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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16
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Sassa N, Yokoyama Y, Nishida Y, Yamada S, Uchida H, Kajiyama H, Nagino M, Kodera Y, Gotoh M. Clinical characteristics and surgical outcomes of retroperitoneal tumors: a comprehensive data collection from multiple departments. Int J Clin Oncol 2020; 25:929-936. [PMID: 31950376 DOI: 10.1007/s10147-020-01620-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are only a limited number of comprehensive reports for retroperitoneal tumors (RPTs). The aim of this study was to perform an interdepartmental data collection for RPTs and to comprehensively clarify the clinical characteristics of this rare disease. METHODS All patients who were diagnosed with RPT from January 2005 to July 2018 in a single institution were included. The analyzed factors included demographics, clinical features, treatment methods, pathological diagnosis, and prognosis. RESULTS A total of 422 patients (215 males and 207 females) with primary RPTs were identified. Biopsy for RPT was performed in 180 patients (43%). Among the 422 patients, 239 (57%) underwent surgery. The most common tissue origin was mesodermal (n = 99, 41%), followed by neurogenic (n = 54, 23%), extragonadal (n = 27, 11%), and metastatic tumors (n = 13, 5%). Among the 99 resected mesodermal tumors, the most common pathological subtypes were liposarcoma (n = 55, 56%) and leiomyosarcoma (n = 16, 16%). The long-term outcomes after surgery were analyzed in patients with intermediate and malignant sarcomas (including liposarcoma, leiomyosarcoma, and others combined, n = 71). The 3- and 5-year disease-free survival rates in the intermediate tumors were 68.2% and 54.2%, respectively, whereas those in the malignant tumors were 48.6% and 28.9%, respectively. The 3- and 5-year overall survival rates in the intermediate tumors were 100% and 94.1%, respectively, whereas those in the malignant tumors were 78.4% and 72.8%, respectively (p = 0.009). CONCLUSIONS The clinical manifestations of RPTs were extremely variable. Recurrence after repeating resection is commonly observed in patients with malignant retroperitoneal sarcoma.
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Affiliation(s)
- Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Department of Gastrointestinal Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. .,Division of Perioperative Medicine, Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Gastrointestinal Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Department of Gastrointestinal Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastrointestinal Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Magnetic resonance imaging of the upper tract (pyelocalyces and ureters) or MR Urography (MRU) is technically possible and when performed correctly offers similar visualization of the upper tracts and for detection of non-calculous diseases of the collecting system similar specificity but with lower sensitivity compared to CTU. MRU provides the ability to simultaneously image the kidneys and urinary bladder with improved soft tissue resolution, better tissue characterization and when combined with assessment of the upper tract, a comprehensive examination of the urinary system. MRU requires meticulous attention to technical details and is a longer more demanding examination compared to CTU. Advances in MR imaging techniques including: parallel imaging, free-breathing motion compensation techniques and compressed sensing can dramatically shorten examination times and improve image quality and patient tolerance for the exam. This review article discusses updates in the MRU technique, summarizes clinical indications and opportunities for MRU in clinical practice and reviews advantages and disadvantages of MRU compared to CTU.
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Magnetic Resonance Imaging of the Perirenal Space and Retroperitoneum. Magn Reson Imaging Clin N Am 2019; 27:77-103. [PMID: 30466914 DOI: 10.1016/j.mric.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Primary retroperitoneal masses constitute a heterogeneous group of uncommon
lesions and represent a challenge due to overlapping imaging findings. Most are
malignant lesions. Although they are more prevalent in adults, they can occur at
any age. Such lesions are classified as primary when they do not originate from
a specific retroperitoneal organ and are divided, according to the image
findings, into two major groups: solid and cystic. The clinical findings are
nonspecific and vary depending on the location of the lesion in relation to
adjacent structures, as well as on its behavior. The main imaging methods used
for staging and surgical planning, as well as for selecting the biopsy site and
guiding the biopsy procedure, are computed tomography and magnetic resonance
imaging. In most cases, the treatment is challenging, because of the size of the
lesions, vascular involvement, or involvement of adjacent organs. In this
article, we present a review of the retroperitoneal anatomy and a practical
approach to the main imaging features to be evaluated, with a view to the
differential diagnosis, which can guide the clinical management.
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Affiliation(s)
- Micaela Maciel Dos Santos Mota
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Regis Otaviano França Bezerra
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Marcio Ricardo Taveira Garcia
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
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20
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Marko J, Wolfman DJ. Retroperitoneal Leiomyosarcoma From the Radiologic Pathology Archives. Radiographics 2018; 38:1403-1420. [PMID: 30207936 PMCID: PMC6166742 DOI: 10.1148/rg.2018180006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Leiomyosarcoma is a malignant neoplasm that shows smooth muscle differentiation. It is the second most common sarcoma to affect the retroperitoneum. Retroperitoneal leiomyosarcomas may grow to large sizes before detection and may be an incidental finding at imaging. When symptomatic, retroperitoneal leiomyosarcoma may cause compressive symptoms, including pain. Retroperitoneal leiomyosarcoma most commonly manifests as a large soft-tissue mass, with areas of necrosis. The most frequent pattern of growth is an entirely extravascular mass. Less commonly, leiomyosarcoma may demonstrate both extravascular and intravascular components. Rarely, retroperitoneal leiomyosarcomas are completely intravascular, typically arising from the inferior vena cava. Given its variable imaging features, a large variety of neoplastic and nonneoplastic conditions are included in the differential diagnosis of retroperitoneal leiomyosarcoma. In this review, the authors discuss retroperitoneal leiomyosarcoma, with emphasis on the pathologic basis of disease, and illustrate the multimodality imaging appearances of retroperitoneal leiomyosarcoma using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. The authors review important differential considerations of retroperitoneal leiomyosarcoma, focusing on the extravascular pattern of growth, and emphasize clinical and imaging features that help radiologists differentiate leiomyosarcoma from the most frequent mimics. The information presented in this review will aid radiologists in fulfilling their key roles in the diagnosis, operative planning, and follow-up of patients with retroperitoneal leiomyosarcoma.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
| | - Darcy J. Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
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21
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Kanemura T, Satake K, Nakashima H, Segi N, Ouchida J, Yamaguchi H, Imagama S. Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery. Spine Surg Relat Res 2017; 1:107-120. [PMID: 31440621 PMCID: PMC6698495 DOI: 10.22603/ssrr.1.2017-0008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/31/2017] [Indexed: 01/10/2023] Open
Abstract
Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra- and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.
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Affiliation(s)
- Tokumi Kanemura
- Department of Orthopedic Surgery, Spine Center, Konan Kosei Hospital, Aichi, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Spine Center, Konan Kosei Hospital, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Spine Center, Konan Kosei Hospital, Aichi, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Spine Center, Konan Kosei Hospital, Aichi, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Spine Center, Konan Kosei Hospital, Aichi, Japan
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
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22
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Lee TP, Huang WC. Pneumoretroperitoneum from a gas-containing retroperitoneal abscess. Tzu Chi Med J 2017; 29:185-186. [PMID: 28974917 PMCID: PMC5616003 DOI: 10.4103/tcmj.tcmj_66_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ta-Pin Lee
- Department of Radiology, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Wen-Chih Huang
- Department of Anatomic Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Terzic B, Spasic M, Djuric P, Vasiljevic V, Radjen S, Mijuskovic M. Retroperitoneal fibrosis and constrictive pericarditis-IgG4 related diseases: A case report. Exp Ther Med 2017; 13:3603-3606. [PMID: 28588687 DOI: 10.3892/etm.2017.4425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/20/2017] [Indexed: 12/24/2022] Open
Abstract
Retroperitoneal fibrosis (RPF) is a rare disease characterized by infiltration of inflammatory cells and deposition of thickened fibrous tissues. The present study presents the case of a 53-year-old patient treated for generalized weakness and fatigue for 1 year prior to hospitalization. A cardiac ultrasound revealed pericardial effusion that required pericardiocentesis, during which 1,400 ml serous fluid with the characteristics of an exudate was aspirated. A pericardiectomy was performed due to persistent effusion and histological examination indicated pericardial fibrosis. A thoracic-abdominal computed tomography scan revealed the presence of retroperitoneal fibrosis. The patient was treated with corticosteroids and azathioprine. Follow-up examinations showed a significant reduction in the amount of abdominal fibrous tissue and no increase in pericardial effusion 1 year following the end of treatment. The patient continues to have regular follow-up control examinations with a cardiologist and nephrologist.
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Affiliation(s)
- Brankica Terzic
- Nephrology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | - Marijan Spasic
- Cardiology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | - Predrag Djuric
- Cardiology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | | | - Slavica Radjen
- Institute of Hygiene, Military Medical Academy, 11000 Belgrade, Serbia
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Laroche AS, Bell RZ, Bezzaoucha S, Földes E, Lamarche C, Vallée M. Retroperitoneal fibrosis: retrospective descriptive study on clinical features and management. Res Rep Urol 2016; 8:175-179. [PMID: 27822461 PMCID: PMC5087765 DOI: 10.2147/rru.s115448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Retroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function. METHODS We conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital. RESULTS We identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18 years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes. CONCLUSION Most of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not.
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Affiliation(s)
| | | | | | - Eva Földes
- Section of Internal Medicine, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
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25
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Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction. Urologia 2016; 83:99-102. [PMID: 26350043 DOI: 10.5301/uro.5000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. PATIENTS This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. DISCUSSIONS Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. CONCLUSIONS We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection.
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26
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Suárez-Mejías C, Pérez-Carrasco JA, Serrano C, López-Guerra JL, Parra-Calderón C, Gómez-Cía T, Acha B. Three-dimensional segmentation of retroperitoneal masses using continuous convex relaxation and accumulated gradient distance for radiotherapy planning. Med Biol Eng Comput 2016; 55:1-15. [PMID: 27099157 DOI: 10.1007/s11517-016-1505-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022]
Abstract
An innovative algorithm has been developed for the segmentation of retroperitoneal tumors in 3D radiological images. This algorithm makes it possible for radiation oncologists and surgeons semiautomatically to select tumors for possible future radiation treatment and surgery. It is based on continuous convex relaxation methodology, the main novelty being the introduction of accumulated gradient distance, with intensity and gradient information being incorporated into the segmentation process. The algorithm was used to segment 26 CT image volumes. The results were compared with manual contouring of the same tumors. The proposed algorithm achieved 90 % sensitivity, 100 % specificity and 84 % positive predictive value, obtaining a mean distance to the closest point of 3.20 pixels. The algorithm's dependence on the initial manual contour was also analyzed, with results showing that the algorithm substantially reduced the variability of the manual segmentation carried out by different specialists. The algorithm was also compared with four benchmark algorithms (thresholding, edge-based level-set, region-based level-set and continuous max-flow with two labels). To the best of our knowledge, this is the first time the segmentation of retroperitoneal tumors for radiotherapy planning has been addressed.
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Affiliation(s)
- Cristina Suárez-Mejías
- Technological Innovation Group, Virgen del Rocío University Hospital, Seville, Spain.
- Signal Theory and Communications Department, University of Seville, Seville, Spain.
| | | | - Carmen Serrano
- Signal Theory and Communications Department, University of Seville, Seville, Spain
| | | | - Carlos Parra-Calderón
- Technological Innovation Group, Virgen del Rocío University Hospital, Seville, Spain
| | - Tomás Gómez-Cía
- Surgery Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Begoña Acha
- Signal Theory and Communications Department, University of Seville, Seville, Spain
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Abstract
Primary retroperitoneal masses include a diverse, and often rare, group of neoplastic and non-neoplastic entities that arise within the retroperitoneum but do not originate from any retroperitoneal organ. Their overlapping appearances on cross-sectional imaging may pose a diagnostic challenge to the radiologist; familiarity with characteristic imaging features, together with relevant clinical information, helps to narrow the differential diagnosis. In this article, a systematic approach to identifying and classifying primary retroperitoneal masses is described. The normal anatomy of the retroperitoneum is reviewed with an emphasis on fascial planes, retroperitoneal compartments, and their contents using cross-sectional imaging. Specific radiologic signs to accurately identify an intra-abdominal mass as primary retroperitoneal are presented, first by confirming the location as retroperitoneal and secondly by excluding an organ of origin. A differential diagnosis based on a predominantly solid or cystic appearance, including neoplastic and non-neoplastic entities, is elaborated. Finally, key diagnostic clues based on characteristic imaging findings are described, which help to narrow the differential diagnosis. This article provides a comprehensive overview of the cross-sectional imaging features of primary retroperitoneal masses, including normal retroperitoneal anatomy, radiologic signs of retroperitoneal masses and the differential diagnosis of solid and cystic, neoplastic and non-neoplastic retroperitoneal masses, with a view to assist the radiologist in narrowing the differential diagnosis.
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28
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de Oliveira Schiavon JL, Tostes VS, Regacini R, Lederman HM. MRI Evaluation of Pediatric Malignant Abdominal Tumors. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Osman S, Lehnert BE, Elojeimy S, Cruite I, Mannelli L, Bhargava P, Moshiri M. A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol 2014; 42:191-208. [PMID: 24070713 DOI: 10.1067/j.cpradiol.2013.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A clear understanding of the normal anatomy and pattern of disease spread is important in evaluating many retroperitoneal disorders. Primary retroperitoneal tumors are uncommon, accounting for 0.1%-0.2% of all malignancies in the body; 80%-90% of all primary retroperitoneal tumors are malignant. The primary retroperitoneal neoplasms can be divided into solid or cystic masses. The solid neoplasms can be classified according to their tissue of origin into 3 main categories: mesodermal tumors, neurogenic tumors, and extragonadal germ cell tumors. Computed tomography and magnetic resonance imaging play a vital role in the localization, characterization, evaluation of the extent of local invasion, assessment of metastases, and determination of treatment response for these tumors. The diagnosis of a primary retroperitoneal malignancy is often challenging owing to overlap of imaging findings. A definitive diagnosis can be established only at histopathologic analysis. However, knowledge of the important tumor characteristics, growth pattern, and vascularity can assist in narrowing the differential diagnosis.
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Affiliation(s)
- Sherif Osman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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30
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Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc 2013; 6:281-91. [PMID: 23940419 PMCID: PMC3731110 DOI: 10.2147/jmdh.s45443] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation
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31
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Goenka AH, Shah SN, Remer EM, Berber E. Adrenal imaging: a primer for oncosurgeons. J Surg Oncol 2012; 106:543-8. [PMID: 22886706 DOI: 10.1002/jso.23235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/10/2012] [Indexed: 12/21/2022]
Abstract
Differentiation of an incidental adrenal lesion into benign and malignant etiologies is an endeavor with significant and obvious clinical benefit. Advances in imaging now enable this differentiation in high proportion of patients in a non-invasive manner. The ACR guidelines elaborated in this review seek to promote clinically meaningful, evidence-based approach to an IAL. Knowledge of the potential as well the limitations of individual modalities is essential so as to streamline investigations in a cost-effective manner.
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Affiliation(s)
- Ajit H Goenka
- Section of Abdominal Imaging, Cleveland Clinic, Imaging Institute, Cleveland, Ohio 44195, USA
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