Extraperitoneal pelvic leiomyosarcoma. MR findings in a case

Concentrated ascites re-infusion therapy for pseudo-Meigs' syndrome complicated by massive ascites in large pedunculated uterine leiomyoma

Pseudo-Meigs' syndrome accompanied by massive ascites in uterine leiomyoma is rare. We encountered a rare case of a 37-year-old, nulliparous woman with a lower abdominal tumor and severe abdominal distention due to massive ascites. Serum cancer antigen 125 and vascular endothelial growth factor levels were elevated to 1007.9 U/mL and 103 pg/mL, respectively. She was tentatively diagnosed with ovarian cancer. Emergency concentrated ascites re-infusion therapy was performed to improve dyspnea, abdominal pain, and her preoperative respiratory condition. Concentrated ascites re-infusion therapy eliminated dyspnea and abdominal discomfort without decreasing serum albumin levels. The patient underwent laparotomy, which revealed a fist-sized pedunculated uterine leiomyoma arising from the right uterine fundus. Myomectomy was performed. Pseudo-Meigs' syndrome mimics advanced ovarian cancer due to massive ascites and markedly elevated serum cancer antigen 125 and vascular endothelial growth factor levels. Concentrated ascites re-infusion therapy was effective in improving the subjective symptoms of pseudo-Meigs' syndrome and the patient's preoperative condition.

Imaging of the retroperitoneum

The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. It extends from the diaphragm superiorly to the pelvic brim inferiorly. This article discusses clinically relevant anatomy of the abdominal retroperitoneal spaces, their cross-sectional imaging evaluation with computed tomography and magnetic resonance imaging, and the imaging features of common retroperitoneal pathologic processes.

Endovascular treatment of an acutely ruptured abdominal aorta from tumor invasion by an unresectable retroperitoneal leiomyosarcoma

Retroperitoneal leiomyosarcomas account for <1% of all tumors diagnosed in the U.S. They are usually unresectable at the time of diagnosis due to their vague clinical presentation. Aortic rupture from tumor invasion by retroperitoneal leiomyosarcomas is extremely rare and has only been described in one case report. We describe a case of an unresectable retroperitoneal leiomyosarcoma eroding into the infrarenal abdominal aorta resulting in an acute contained intratumoral hemorrhage successfully treated with a percutaneous placed abdominal aortic endograft. This article discusses the endovascular treatment of this rare medical emergency performed quickly and effectively in our endovascular suite. Endovascular specialists should be familiar with this lifesaving endovascular option in the setting of an acute aortic rupture.