Primary Retroperitoneal Müllerian Adenocarcinoma: Report of Two Cases Treated With Radical Surgery

BACKGROUND

Primary retroperitoneal Müllerian adenocarcinoma (PRMA) is a very rare type of primary retroperitoneal tumour. CASE 1: A 45-year-old woman presented with left lower extremity swelling and pain. Imaging revealed that the tumour had invaded the left common iliac vein and artery, internal and external iliac arteries, sciatic and obturator nerves, and pelvic wall. CASE 2: A 37-year-old was admitted with pelvic pain. Imaging showed the tumor at the left iliac bifurcation infiltrating the internal iliac artery and left sciatic, obturator, and femoral nerves. Both of these patients were treated with radical surgery that achieved no visible tumour at the end of the operation.

CONCLUSION

There is no guideline for the diagnosis and management of this entity due to its rarity. These cases should be managed at highly specialized centres with expertise in radical surgery.

Laparoscopic Resection and Pre-Operative Imaging of Primary Retroperitoneal Mucinous Neoplasms: A Retrospective Case Series

Purpose

The purpose of this paper is to present the clinicopathological features of primary retroperitoneal mucinous neoplasms (PRMNs), to evaluate the diagnostic role of pre-operative radiological examinations, and to determine the feasibility of total resection using the laparoscopic approach.

Methods

We retrospectively analysed the clinicopathological and radiological features of 10 PRMN cases who underwent surgical resection from January 2000 to December 2019.

Results

Ten PRMN cases were evaluated in this study, including 1 malignant case, 4 borderline cases, and 5 benign cases. The most common primary complaints were pain (60%) and palpable mass (60%). Of the 8 cases with pre-operative CT results, 75% of the borderline or malignant cysts and none of the benign cysts were large in size (size>11.6 cm). Half of the non-benign masses and none of the benign ones were lobulated. Thick wall (≥3 mm) and irregular wall were found in 25% and 50% of the non-benign cases, respectively. Wall enhancement was detected in 75% of the non-benign cases and 25% of the benign cases. Enhanced mural nodules were identified in 50% of the non-benign patients. Septa were found in 25% of the non-benign cases. Complete dissection of the tumour without rupture or post-operative complications was achieved laparoscopically in 90% of the cases. All patients were alive with no recurrence at the last follow-up at an average of 28.1±26.6 months.

Conclusion

Larger size and lobulation of the cyst, presence and contrast enhancement of thick and irregular cyst walls, mural nodules, and internal septa may be imaging features suggestive of malignancy. Complete resection of PRMN through the laparoscopic approach is feasible in experienced institutions.

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.