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Al Laham O, Adi A, Alaitouni A, Sharaf Aldeen R, Alshiekh A, Hamed H. An enormous benign primary retroperitoneal mucinous cystadenoma: a case report and literature review of a seldom seen abdominal pathology. Ann Med Surg (Lond) 2023; 85:5736-5741. [PMID: 37915663 PMCID: PMC10617834 DOI: 10.1097/ms9.0000000000001335] [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: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Retroperitoneal neoplasia comprise less than 2% of all tumours. benign primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumour. Their clinical course is overall silent unless the patient presents with a vague abdominal or pelvic pain, abdominal distention, or a palpable mass. Their aetiology remains theorized and since 1989, only 46 cases (excluding ours) worldwide were documented in the literature. The majority of cases were discovered in females but the overall tumour incidence rate is still undetermined due to its rarity. Well-timed recognition of this pathology permits the necessary curative surgical intervention to take place. Case presentation We hereby illustrate the rare case of a 23-year-old female who presented to the surgical clinic complaining solely of an unexplained gradual increase of the abdominal contour. Their presurgical radiological analysis yielded an intraabdominal large-sized well-demarcated retroperitoneal mass. Clinical discussion Thorough resection of the mass was accomplished via open surgery. The subsequent microscopic analysis of excised tumour yielded the diagnosis of primary retroperitoneal mucinous cystadenoma of benign nature. Conclusion Primary retroperitoneal mucinous cystadenoma is a seldom seen tumour. The scarcity of its occurrence is further highlighted by the published data. Based on their conclusive review of the available published English-based literature, ours is the 47th documented case of a benign PRMC and it is the first documented case from our country; Syria. The impact of these findings warrants raising awareness on the subject and considering PRMC as a differential diagnosis when presented with a similar case in the clinical practice.
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Affiliation(s)
- Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Amir Adi
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Radiology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Aliaa Alaitouni
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Pathology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Ali Alshiekh
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Hamoud Hamed
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
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Geetha SD, Kavoussi L, Thomas R, Savant D. Primary Retroperitoneal Mucinous Cystadenocarcinoma: A Case Report. Cureus 2023; 15:e39983. [PMID: 37415996 PMCID: PMC10321359 DOI: 10.7759/cureus.39983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
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.
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Nguyen K, Siegelman ES, Tu W, Schieda N. Update on MR Imaging of cystic retroperitoneal masses. Abdom Radiol (NY) 2020; 45:3172-3183. [PMID: 31501965 DOI: 10.1007/s00261-019-02196-9] [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: 11/28/2022]
Abstract
OBJECTIVE This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. CONCLUSION Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.
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Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Evan S Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Danen C, Leschke T, Bassi D, Sharma R. First Report of Retroperitoneal Mucinous Cystadenoma in a Patient with Hirsutism. Clin Med Res 2020; 18:27-32. [PMID: 31582418 PMCID: PMC7153794 DOI: 10.3121/cmr.2019.1488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022]
Abstract
Primary retroperitoneal mucinous cystadenomas (PRMC) are rare benign neoplasms with only 55 documented cases in the English literature so far. A 19-year-old female exhibited hirsutism and was found to have a cystic mass measuring 5.8 cm × 3.9 cm × 5.8 cm in the left retroperitoneum. During subsequent work up, a high pre-operative value of dehydroepiandrosterone sulfate (DHEA-S) was noted. The patient was referred to surgical oncology and underwent an uneventful laparoscopic cystectomy. Pathology classified the cyst as PRMC. Post-operatively, the patient's DHEA-S levels normalized, though there was no appreciable decrease in the patient's hirsutism in the short-term follow-up. The origin of PRMC is uncertain. Due to their unknown biological potential, surgical resection is usually recommended. To the best of our knowledge, this is the first report documenting a PRMC and elevated levels of androgens in conjunction with hirsutism.
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Affiliation(s)
- Ciera Danen
- Department of General Surgery, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Thomas Leschke
- Department of General Surgery, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Deepa Bassi
- Department of Pathology, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Rohit Sharma
- Department of General Surgery, Marshfield Clinic, Marshfield, Wisconsin, USA
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Pesapane F, Van Renterghem S, Patella F, De Visschere P, Villeirs G. A case report and a literature review of primary retroperitoneal mucinous cystadenoma: the importance of imaging in diagnosis and management. Future Oncol 2018; 14:2923-2931. [DOI: 10.2217/fon-2017-0649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumor: its histogenesis and its biological behavior remain speculative. Since most retroperitoneal tumors are malignant, a preoperative diagnosis of benignity is essential and it can be reached through imaging examinations, allowing a conservative management approach. We describe the case of a 52-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy and diagnosed as PRMC. Although there are no pathognomonic, clinical or radiological findings for PRMC, it should be included in the list of differential diagnoses and its imaging criteria of benignity should always be sought, with the aim to exclude malignant tumors.
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Affiliation(s)
- Filippo Pesapane
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milano, MI, Italy
| | - Sofie Van Renterghem
- Department of Pathology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milano, MI, Italy
| | - Pieter De Visschere
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Abstract
Mucinous cystadenomas and cystadenocarcinomas of the ovary are clinically and histopathologically well-established common tumors. However, primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Most authors suggest that they develop through mucinous metaplasia in a preexisting mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. Delay in diagnosis and treatment of this tumor may be fatal for the patient because of complications such as rupture, infection, and malignant transformation. We describe the case of a 31-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy. Histopathological examination of the resected mass confirmed the diagnosis of a primary retroperitoneal mucinous cystadenoma. The patient was discharged on postoperative day 5 without any complications.
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Affiliation(s)
- Seok Youn Lee
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Weon Cheol Han
- Department of Pathology, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Lee SE, Oh HC, Park YG, Choi YS, Kim MK. Laparoscopic excision of primary retroperitoneal mucinous cystadenoma and malignant predicting factors derived from literature review. Int J Surg Case Rep 2015; 9:130-3. [PMID: 25768279 PMCID: PMC4392370 DOI: 10.1016/j.ijscr.2015.02.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Primary retroperitoneal mucinous cystic neoplasm is very rare and its histogenesis is unclear. PRESENTATION OF CASE This paper presents the case of a 31-year-old female in whom an incidentally detected retroperitoneal cystic mass, 6.5cm in size, was successfully resected through laparoscopic approach. Pathologic examination revealed a mucinous cystadenoma. The postoperative course was uneventful, and the patient remained free of recurrence six months after surgery. DISCUSSION Literature review showed that male sex (p=0.019), and solid nodules in cysts (p<0.001) were both significantly associated with malignancy. CONCLUSION When confronted with a cystic mass in the retroperitoneum, a primary mucinous cystic neoplasm should be considered and complete surgical removal of the tumor without spillage is recommended.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Republic of Korea.
| | - Hyung Chul Oh
- Department of Internal Medicine, Division of Gastroenterology, Chung-Ang University College of Medicine, Republic of Korea
| | - Yong-Gum Park
- Department of Surgery, Chung-Ang University College of Medicine, Republic of Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Republic of Korea
| | - Mi Kyung Kim
- Department of Pahtology, Chung-Ang University College of Medicine, Republic of Korea
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Santo-Filho MA, COLLEONi R, Shigueoka DC, Artigiani R, Scalabrini M, Lopes-Filho GDJ. Primary retroperitoneal mucinous cystadenoma - case report. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27:224-6. [PMID: 25184778 PMCID: PMC4676366 DOI: 10.1590/s0102-67202014000300016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 05/13/2014] [Indexed: 11/22/2022]
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Paraskevakou H, Orfanos S, Diamantis T, Konstantinidou A, Patsouris E. Primary retroperitoneal mucinous cystadenoma. A rare case with two cysts and review of the literature. Hippokratia 2014; 18:278-281. [PMID: 25694766 PMCID: PMC4309152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Primary retroperitoneal mucinous cystadenoma is a rare neoplasm, with benign biological behavior. Delay in diagnosis and treatment of this tumor may be fatal for the patient, because of complications, such as rupture, infection and malignant transformation. CASE PRESENTATION We present a 23-year-old woman, who was admitted to the hospital because of a palpable abdominal mass and discomfort since 4 months. Computed Tomography and Magnetic Resonance Imaging scans were performed and showed two retroperitoneal cystic masses, which were excised by laparoscopy. Histological and immunohistochemical examination revealed that the inner surfaces of the cysts were lined by epithelium with features of mesothelial cells, in addition to ovarian mucinous cystadenoma. This is the 29(th) case and the second reported case with two contemporary cysts. CONCLUSION The origin of retroperitoneal mucinous cystadenomas is still unclear. Pathological and immunohistochemical findings proved that these tumors resemble ovarian mucinous cystadenomas but are unattached to the ovary and can arise at any location in the retroperitoneum. Surgical excision of the aforementioned tumors is the treatment of choice. Hippokratia 2014; 18 (3): 278-281.
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Affiliation(s)
- H Paraskevakou
- 1 Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S Orfanos
- 1 Department of Surgery, University of Athens, Laiko Athens General Hospital,Athens, Greece
| | - T Diamantis
- 1 Department of Surgery, University of Athens, Laiko Athens General Hospital,Athens, Greece
| | - A Konstantinidou
- 1 Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Patsouris
- 1 Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Primary retroperitoneal mucinous cystadenoma with a sarcoma-like mural nodule: an immunohistochemical study with histogenetic considerations and literature review. Int J Gynecol Pathol 2013. [PMID: 23202791 DOI: 10.1097/pgp.0b013e31825f7c41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary retroperitoneal mucinous cystadenomas (PRMCs) are extremely rare tumors and their association with sarcoma-like mural nodules (SLMNs) has not been described thoroughly. The aim of this study is to characterize the gross and microscopic features and the immunohistochemical profile of the first case of PRMC with SLMN and to discuss the differential diagnosis of SLMNs. The literature related to primary retroperitoneal mucinous tumors is reviewed in an attempt to clarify the histogenesis of the epithelial and sarcomatoid components of the associated mural nodules. A 34-yr-old woman presented with a 14-cm retroperitoneal cystic lesion with a 6-cm mural nodule. An immunohistochemical study with a panel of 19 antibodies and a histochemical study for mucin stains were performed. The epithelial component of the PRMC showed positive staining for cytokeratin (CK) 7, CK AE1/3, epithelial membrane antigen, carcinoembryonic antigen, and calretinin. The neoplasm was not immunoreactive for CK 20, CK 5/6, and the other antibodies used in this study. In addition, it stained positively for mucin by mucicarmine, periodic acid-Schiff, and Alcian blue. The stromal cells of the cyst showed estrogen receptor positivity. SLMN cells were negative for all CKs and other epithelial markers used in the study, but they showed diffuse positive staining for vimentin and CD68, and positive staining for Ki-67 was demonstrated in 25% of these cells. The immunohistochemical and histochemical profiles of PRMC were similar to those of ovarian mucinous neoplasms and the mesothelium. The formation of SLMNs seems to be related to subepithelial hemorrhage and some reactive epithelial changes near the mural nodules. The specific immunohistochemical and morphologic features of SLMNs are helpful in differentiating them from malignant mural nodules, including true sarcomas, osteoclast-rich undifferentiated carcinomas, and carcinosarcomas. Such a differentiation is critical in view of its significant impact on the management of these neoplasms, particularly in young patients who desire to preserve their fertility.
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Navin P, Meshkat B, McHugh S, Beegan C, Leen E, Prins H, Aly S. Primary retroperitoneal mucinous cystadenoma-A case study and review of the literature. Int J Surg Case Rep 2012; 3:486-8. [PMID: 22809878 DOI: 10.1016/j.ijscr.2012.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/11/2012] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Primary retroperitoneal tumours of mucinous type are extremely rare and can be further sub-divided into benign, borderline or cystadenocarcinoma. Prompt diagnosis of retroperitoneal tumours is important as the majority are malignant. PRESENTATION OF CASE Our case describes a 30year old woman, presenting with a 3month history of intermittent right iliac fossa pain. Abdominal examination demonstrated a mass palpable in the right iliac fossa. Ultrasonography of the abdomen demonstrated a cystic mass with a magnetic resonance imaging (MRI) scan of the pelvis further defining the lesion. Laparoscopy was performed to further evaluate and ultimately remove the retroperitoneal mass. Macroscopic and microscopic examination reported mucinous epithelium of endocervical type with no evidence of invasion. Findings were consistent with primary retroperitoneal mucinous cystadenoma. DISCUSSION This is the 19th reported case of a benign primary retroperitoneal mucinous cystadenoma in the English literature. The origin of mucinous cystadenomas in the retroperitoneum is widely debated with multiple theories suggested. Diagnosis of retroperitoneal tumours is important but difficult as serological investigations, ultrasonography, computed topography and magnetic resonance imaging, although useful, cannot allow a confident diagnosis. CONCLUSION Primary retroperitoneal mucinous cystadenoma is a benign tumour, however because of the malignant nature of the majority of mucinous retroperitoneal tumours they should be considered in the differential of chronic abdominal pain despite their rarity.
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Affiliation(s)
- P Navin
- Department of Surgery, Connolly Memorial Hospital, Blachardstown, Dublin 15, Ireland
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Primary retroperitoneal mucinous cystadenoma. Arch Gynecol Obstet 2009; 280:479-83. [DOI: 10.1007/s00404-008-0925-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
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Yan SL, Lin H, Kuo CL, Wu HS, Huang MH, Lee YT. Primary retroperitoneal mucinous cystadenoma: Report of a case and review of the literature. World J Gastroenterol 2008; 14:5769-72. [PMID: 18837099 PMCID: PMC2748217 DOI: 10.3748/wjg.14.5769] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. We describe a 29-year-old woman with abdominal pain and a palpable mass. Computed tomography (CT) of the abdomen revealed a retroperi-toneal cystic mass which was resected successfully at laparotomy. Histopathological examination of the resected mass confirmed the diagnosis of RMC. There was no evidence of disease 2 years after surgery.
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Kim YS, Oh CY, Rha KH, Cho NH. Successful Removal of Primary Retroperitoneal Mucinous Cystadenoma by Laparoscopic Surgery. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.9.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Soo Kim
- Department of Urology, Urological Science Institute, Seoul, Korea
| | - Cheol Young Oh
- Department of Urology, Urological Science Institute, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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