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Singh U, Roy S, Gaurav K, Anand A, Sonkar AA. Primary Right Adrenal Teratoma in a Postmenopausal Female: a Case Report and Review of Literature. Indian J Surg Oncol 2024; 15:185-192. [PMID: 38511013 PMCID: PMC10948675 DOI: 10.1007/s13193-023-01863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/06/2023] [Indexed: 03/22/2024] Open
Abstract
Non-seminomatous germ cell tumors with structural components from all three cellular lineages are called teratomas. We report a rare case of a primary right adrenal teratoma in a postmenopausal female, presenting with abdominal pain. Ultrasound revealed a complex cystic shadow in the perihepatic region superior to the upper pole of the right kidney, which was suggestive of a complex supra-renal space-sequence-occupying lesion. Computerized tomography revealed a large-sized mature single multilobulated complex cystic lesion in the right hypochondrial lumbar region arising from the right adrenal gland. A right-sided transperitoneal adrenalectomy was performed. The resected mass (18 × 13 × 10 cm) was well encapsulated. Cut surfaces showed cystic mass filled with necrotic gray-white pultaceous material, along with a solid white gelatinous area. Microscopic sections showed a tumor which displayed differentiation along various tissue lineages. After immunohistochemical examinations, the tumor was confirmed to be a mature cystic teratoma. Mature teratomas show a good prognosis, and surgical resection and follow-up remain the standard approach.
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Affiliation(s)
- Utkarsh Singh
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Kushagra Gaurav
- Department of General Surgery, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, Uttar Pradesh 226003 India
| | - Akshay Anand
- Department of General Surgery, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, Uttar Pradesh 226003 India
| | - Abhinav A. Sonkar
- Department of General Surgery, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, Uttar Pradesh 226003 India
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Di Giambenedetto S, Fagotti A, Quaranta G, Iannone V, Fancello G, Steiner RJ, Mazzon G, Masucci L, Teodorico E, Borghetti A, Naldini A, Scambia G. Reporting a single case of cystic echinococcosis in retroperitoneal mass of uncertain origin. Parasitol Res 2023; 123:40. [PMID: 38095718 DOI: 10.1007/s00436-023-08018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
Echinococcal disease (hydatid disease (HD) is an endemic parasitosis caused by Echinococcus granulosus in the larval stage, and it is typically due to the production of unilocular cystic lesions, usually involving the liver for the majority of patients and the lungs in 25%, but also any other organs can be potentially involved in developing echinococcal disease. We report a case of extrahepatic, retroperitoneal echinococcal disease, caused by Echinococcus granulosus. The patient underwent a surgical removal of the abdominal mass, revealed by abdominal ultrasound and computerized tomography scanning, and in the founded clinical and radiological suspicion of echinococcal disease, multiple bioptical samples were sent for microbiological analysis and albendazole therapy was started; Echinococcus granulosus protoscolices were found on the bioptical sample, and the diagnosis was successfully confirmed. According to the current parasitology literature on echinococcal disease, extrahepatic localization, although rare, can be found, and it should be considered in the differential diagnosis of an abdominal mass when epidemiological risk factors and anamnestic data are present, regardless of the usual site of the disease.
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Affiliation(s)
- Simona Di Giambenedetto
- Department of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Department of Woman, Child, and Public Health, UOC Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Quaranta
- Department of Laboratory and Infectious Sciences, A. Gemelli University Hospital IRCCS, 00168, Rome, Italy
| | - Valentina Iannone
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy.
| | - Giovanni Fancello
- Department of Laboratory and Infectious Sciences, A. Gemelli University Hospital IRCCS, 00168, Rome, Italy
| | - Rebecca Jo Steiner
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Mazzon
- Department of Diagnostic Imaging, Radiation Oncology and Hematology; UOC Radiology and Neuroradiology, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Masucci
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Elena Teodorico
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- Department of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy
| | - Angelica Naldini
- Department of Security and Bioethics, Infectious Disease, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Department of Woman, Child, and Public Health, UOC Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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3
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Li X, Zhang W. Clinical application of real-time PET/CT guided targeted retroperitoneal masses biopsy in diagnosing malignant tumors. BMC Cancer 2023; 23:829. [PMID: 37670264 PMCID: PMC10481464 DOI: 10.1186/s12885-023-11334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and clinical application value based on the fusion image of 18 F-FDG PET/CT, for guiding retroperitoneal puncture biopsy technology and to determine the diagnosis of retroperitoneal masses in diagnosing malignant tumors. METHODS From March 2019 to January 2023, 42 patients underwent 18 F-FDG PET/CT imaging and were found to have retroperitoneal lesions that required definite diagnosis; 22 were male, 20 were female, and the average age was(59.17 ± 13.23) years. According to the fused 18 F-FDG PET/CT tomographic image, the target point with the highest metabolic activity, the safest, and expected maximum sample size was selected. CT scans were acquired with the same machine and fused with 18 F-FDG PET, guiding the puncture biopsy needle to approach the expected target zone, enabling timely delivery of pathological and immunohistochemical examination of the biopsy. Success rate, total examination time, biopsy operation time, complications, CT radiation dose, pathological, and immunohistochemical results were recorded. RESULTS All 42 patients were sampled successfully with the successful rate being 100%. The site of sampling of 42 patients accurately targeted the highest metabolic activity, the safest, and the expected maximum sample size. All 42 patients received clear diagnosis (25 cases of malignant tumors and cases of 17 benign tissues). 15 cases of patients had a change in clinical diagnosis, accounting for 35.7% of all patients, and affecting subsequent treatment plans. The average total examination time for patients was (41.3 ± 7.3) minutes, and the biopsy operation time was (29.1 ± 8.7) minutes. The effective radiation dose generated by the entire examination generated by CT guidance was (2.0 ± 0.5) mSv; no severe complications occurred in the patients. CONCLUSION Real-time-guided retroperitoneal puncture biopsy based on 18 F-FDG PET/CT fusion image is safe, accurate, and feasible, and can provide patients of retroperitoneal mass with clear pathological diagnosis and immunohistochemical evaluation.
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Affiliation(s)
- Xiaomin Li
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Wanchun Zhang
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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Zebbakh H, Imrani K, Lemrabet A, Aaboudech TY, Bernoussi Z, MoatassimBillah N, Nassar I. Retroperitoneal lymphatic malformations: A case report. Radiol Case Rep 2023; 18:3175-3178. [PMID: 37404219 PMCID: PMC10315919 DOI: 10.1016/j.radcr.2023.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Retroperitoneal lymphatic malformation is a rare benign vascular malformation, of various locations, which can reveal itself at any age in its abdominal localizations. The retroperitoneal localization of this malformation is extremely rare. The clinical symptomatology is polymorphic depending on the lesion volume and the presence or absence of complications. The diagnosis is evoked by the liquid character of the retroperitoneal mass on ultrasound, CT scan and abdomino-pelvic MRI, brought during surgery and confirmed by the histological study of the surgical specimen. The treatment of choice is complete surgical removal of the mass.
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Affiliation(s)
- Hajar Zebbakh
- Central Radiology Department, Ibn Sina University Hospital, Madinat Al Irfane, Rabat, 10112, Maroc
| | - Kaoutar Imrani
- Central Radiology Department, Ibn Sina University Hospital, Madinat Al Irfane, Rabat, 10112, Maroc
| | - Abir Lemrabet
- Central Radiology Department, Ibn Sina University Hospital, Madinat Al Irfane, Rabat, 10112, Maroc
| | - Taha Yassine Aaboudech
- Central Department of Pathological Anatomy and Cytology, Ibn Sina University Hospital, Rabat, Maroc
| | - Zakia Bernoussi
- Central Department of Pathological Anatomy and Cytology, Ibn Sina University Hospital, Rabat, Maroc
| | - Nabil MoatassimBillah
- Central Radiology Department, Ibn Sina University Hospital, Madinat Al Irfane, Rabat, 10112, Maroc
| | - Ittimade Nassar
- Central Radiology Department, Ibn Sina University Hospital, Madinat Al Irfane, Rabat, 10112, Maroc
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Deresse T, Bogale M, Alemayehu D, Dessalegn M, Seid M. Giant renal angiomyolipoma: A case report. Int J Surg Case Rep 2023; 109:108538. [PMID: 37487350 PMCID: PMC10374953 DOI: 10.1016/j.ijscr.2023.108538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Renal angiomyolipoma (AML), which is a rare solid kidney tumor with benign characteristics, also known as a renal hamartoma, can exhibit various clinical symptoms and severe consequences may arise if the lesion becomes large. PRESENTATION OF THE CASE A 58-year-old woman was admitted to a hospital, with general fatigue, abdominal swelling, and epigastric fullness. Upon examination, a large mass was palpated, which occupied almost the entire right abdomen. The abdominal computed tomography scan revealed a large right renal mass measuring 22 × 18 × 8 cm, which was exophytic and heterogeneous with a large fat component and an enhancing solid part. The tumor was successfully excised through a generous right subcostal incision with left-side extension. The total weight of the resected specimen was 2500 g, which appears to be the largest angiomyolipoma ever resected in Ethiopia. DISCUSSION Renal AML, a benign tumor derived from mesenchymal components, is sometimes referred to as a "hamartoma" due to its variable makeup. The most common complaints of patients with renal AML are lower back pain, hematuria, and physical finding of hypotension (shock), though patients with giant AML, as in this case, may also experience gastrointestinal symptoms due to the mass' compression. CONCLUSION Although treatment options requiring contemporary medical technologies and skilled manpower are difficult to offer in set ups of resource-limited countries, such as the one we reported from, giant renal angiomyolipoma can be treated safely with open nephrectomy.
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Affiliation(s)
- Tilahun Deresse
- Department of Surgery, School of Medicine, Debre Berhan University, 445, Ethiopia.
| | - Mandante Bogale
- Department of Surgery, School of Medicine, Debre Markos University, 269, Ethiopia
| | - Dawit Alemayehu
- Department of Surgery, School of Medicine, Debre Markos University, 269, Ethiopia
| | - Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, 269, Ethiopia
| | - Marta Seid
- Department of Surgery, School of Medicine, Saint Paul Hospital Millennium Medical College, Addis Ababa 1271, Ethiopia
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Juste Álvarez S, Miranda Utrera NR, Duarte Ojeda JM, Sopeña Sutil R, Gil Moradillo J, Guerrero-Ramos F, Hernández-Arroyo M, Santos Pérez De La Blanca R, Rodríguez Antolín A, Gomez Del Cañizo C. Extrauterine Retroperitoneal Leiomyomas: 3 Case Reports and Review of the Literature. Urol Int 2023; 107:814-818. [PMID: 37253342 DOI: 10.1159/000530213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/13/2023] [Indexed: 06/01/2023]
Abstract
Leiomyomas are benign mesenchymal tumors which originate from smooth muscle cells. Extrauterine leiomyomas are rare and they may arise where smooth muscle cells are found. Their diagnosis is challenging due to their heterogeneous ways of presentation. Histological analysis may reveal areas of sarcomatous differentiation; therefore, complete resection of the entire tumor is the only curative treatment. There is no adjuvant therapy proved to increase overall survival. It is essential to develop a standardized protocol, detailing how to follow up these patients since it is not reported in the literature to date; however, it is advisable to follow them because the local recurrence rate is high if small implants remain. In this review, we present 3 cases of extrauterine leiomyomas diagnosed and treated in our hospital. The management was different in each case, highlighting the heterogeneity of this condition. According to the literature, there are no solid guidelines on their management. We compare our experience with the data available to date in order to support the existing knowledge and provide our expertise for future studies.
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7
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Gonzalez OER, Castro EIB, Salcedo JGC. Macroscopic hematuria as an initial symptom of testicular cancer, an unusual presentation and initial management. A case report. Int J Surg Case Rep 2022; 101:107799. [PMID: 36434876 PMCID: PMC9685278 DOI: 10.1016/j.ijscr.2022.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia; consequently, this condition presents the greatest clinical challenge due to its broad clinical spectrum, hematuria is an atypical form of presentation of testicular tumors, with very few cases reported in the literature, reaffirming the importance of a complete examination when approaching hematuria in the emergency department. CASE PRESENTATION We present a case of a 31-year-old patient who presented to the emergency department with macroscopic hematuria of 5 weeks of evolution, showing on examination a mass in the left testicle. Imaging studies showed bilateral pulmonary metastatic lesions and retroperitoneal lymph node activity with a retrocaval conglomerate infiltrating the left ureter, for which a radical left orchiectomy and multiple procedures were performed to resolve the hematuria. DISCUSSION Macroscopic hematuria in adolescents or young adults is an infrequent cause of admission to the Emergency Department with a large list of differential diagnoses both benign and malignant so it is necessary to perform exhaustive studies in its approach, when young patients present with a painless testicular mass, it is important to keep testicular cancer within the differential diagnoses, metastatic disease is a rare form of presentation in this type of tumors. The relevance of this clinical case lies in the fact that hematuria was the main symptom that brought the patient to the emergency department, so we must not forget that macroscopic hematuria should be extensively studied. CONCLUSION When approaching a patient with macroscopic hematuria, the clinical history and physical examination is extremely important to provide the best possible care and focus the treatment properly.
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Affiliation(s)
- Orión Erenhú Rodriguez Gonzalez
- Escuela Militar de Graduados de Sanidad, Mexico,Corresponding author at: Periférico Blvrd Manuel Ávila Camacho s/n, Militar, Miguel Hidalgo, 11200 Ciudad de México, Mexico.
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8
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Fourati K, Tlili A, Masmoudi A, Laabidi T, Ben Ameur H, Boujelben S. Primary retroperitoneal hydatid cyst with intraperitoneal rupture: a case report. J Med Case Rep 2022; 16:202. [PMID: 35610709 PMCID: PMC9131640 DOI: 10.1186/s13256-022-03415-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hydatid disease is endemic in Mediterranean countries and most commonly occurs in the liver followed by the lung. A primary localization in the retroperitoneum is extremely rare. Case presentation We report the case of a 29-year-old Tunisian patient presenting with progressive left flank pain and skin urticaria. On abdominal ultrasonography and computed tomography scan, a ruptured retroperitoneal hydatid cyst was diagnosed, which was confirmed by positive hydatid serology. The treatment consisted of resection of protruding dome. The evolution was favorable. No local recurrence was detected during postoperative follow-up. Conclusions Primary retroperitoneal hydatid cyst is extremely rare and has uncommon presentation, but we should learn the keys to its diagnosis. In endemic regions, high suspicion for this disease is justified regardless of localization.
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Affiliation(s)
- Kais Fourati
- Departement of surgery, Habib Bourguiba Hospital, Sfax, Tunisia.,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Ahmed Tlili
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Surgery, Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | - Abderrahmen Masmoudi
- Departement of surgery, Habib Bourguiba Hospital, Sfax, Tunisia. .,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.
| | - Taher Laabidi
- Departement of surgery, Habib Bourguiba Hospital, Sfax, Tunisia.,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hazem Ben Ameur
- Departement of surgery, Habib Bourguiba Hospital, Sfax, Tunisia.,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Salah Boujelben
- Departement of surgery, Habib Bourguiba Hospital, Sfax, Tunisia.,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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9
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Shafqat A, Shafqat S, Sabbah BN, Shaik A, Alfehaid WK, Islam SSU. Inflammatory bowel disease causing retroperitoneal varicosity mimicking a renal artery aneurysm: A novel case report and literature review. Radiol Case Rep 2022; 17:983-986. [PMID: 35106109 PMCID: PMC8784286 DOI: 10.1016/j.radcr.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
A 17-year-old female presented to our hospital complaining of bloody diarrhea 4-6 times per day for the past month. She was a known case of inflammatory bowel disease noncompliant to her medications. Abdominal computed tomography revealed an unusually dilated mass in the retroperitoneum at L2 vertebral level connecting the lumbar and left renal veins. The renal artery was visualized separately, and a diagnosis of communicating vein varicosity was made. This lesion can be misleading on imaging, hence our aim to disseminate our findings to practicing radiologists. The differential diagnosis of these lesions include retroperitoneal lymphadenopathy, renal artery aneurysms, and testicular cancers causing retroperitoneal lymphadenopathy. To our knowledge, this is the first case to be reported in association with inflammatory bowel disease, perhaps providing a novel insight into the pathogenesis of this lesion that has not been considered in the contemporary literature.
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Affiliation(s)
- Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Belal Nedal Sabbah
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Shaik
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
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Noginskiy I, Nimkar N, Kalavar MR. Abscess or Tumor? When a Retroperitoneal Mass on Computerized Tomography Turns Out to Be a Rare Soft Tissue Growth. Case Rep Oncol 2021; 14:1025-1030. [PMID: 34326738 PMCID: PMC8299377 DOI: 10.1159/000516754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
A retroperitoneal finding on a computerized tomography scan, in a symptomatic patient, can harbor the clinician to many differential diagnoses from infectious to malignancy. Desmoid fibromatosis (DF), a relatively innocuous mass that can spread locally, can be found in that anatomical region. Even for a rare tumor such as DF, our patient did not meet the usual benchmarks of this cancer, being an elderly female and having it appear as an abscess radiologically. Timely clinical response with radiotherapy and tamoxifen allowed our patient's DF to regress and resolved her symptoms.
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Affiliation(s)
- Ilya Noginskiy
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Neil Nimkar
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
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11
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Rkik M, Fadil Y, Elidrissi O, Dakir M, Debbagh A, Aboutaieb R. Geant adrenal myelolipoma: A case report with literature review. Urol Case Rep 2021; 35:101541. [PMID: 33376675 PMCID: PMC7758362 DOI: 10.1016/j.eucr.2020.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
Adrenal myelolipoma is a rare, benign, non-functioning tumor, composed of mature adipose tissue and hematopoietic cells. We present the case of a 26-year-old woman who presented with abdominal distention and right back pain radiating to the right hypochondrium. Computed tomography of the abdomen revealed a large retroperitoneal mass, which was suspected to be a retroperitoneal liposarcoma. All hormonal studies related to adrenal gland were within normal limits. Open surgery resection was performed. Histopathology showed an adrenal myelolipoma with 39 × 21.5 × 8.5 cm and weighting 4930 g h. The patient evolved with an uneventful postoperative period.
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Affiliation(s)
- Mustapha Rkik
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
| | - Youssef Fadil
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
| | - Oussama Elidrissi
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
| | - Mohammed Dakir
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
| | - Adil Debbagh
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
| | - Rachid Aboutaieb
- University Hospital Center Ibn Rochd Casablanca, Morocco
- Faculté de Médicine et de Pharmacie Casablanca, Morocco
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Marín-Martínez L, Kyriakos G, Sánchez-Gutiérrez D. Pseudotumoral form of schistosomiasis mimicking neuroendocrine tumor: a case report and brief review of the differential diagnosis of retroperitoneal masses. Pan Afr Med J 2021; 37:186. [PMID: 33447341 PMCID: PMC7778187 DOI: 10.11604/pamj.2020.37.186.26344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023] Open
Abstract
Differential diagnosis of retroperitoneal masses may become complex and requires careful anamnesis, physical examination and several complementary tests. We present the clinical case of a male patient aged 45 years who was diagnosed with a 4cm paraaortic lesion compatible with neuroendocrine tumor in the abdominal computed tomography (CT) exam. The workup performed with SPECT-CT, somatostatin receptors scintigraphy, MIBG scintigraphy, 24-hour urine total and fractionated catecholamines and 24-hour urine 5-OH indoleacetic did not confirm the first diagnostic impression. Finally, the lesion was biopsied and presence of micro-organisms was revealed. Further exams confirmed schistosomiasis as the cause of the paraaortic lesion. Histological diagnosis can be helpful with regard to the differential diagnosis of retroperitoneal masses.
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Affiliation(s)
- Luis Marín-Martínez
- Sección de Endocrinología y Nutrición, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Georgios Kyriakos
- Sección de Endocrinología y Nutrición, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - David Sánchez-Gutiérrez
- Servicio de Anatomía Patológica, Hospital General Universitario Santa Lucía, Cartagena, Spain
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13
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Sammour M, Altheneyan M, Almarzouq Y, Almulhim A, Alhazzani N. Testicular non-seminomatous mixed germ cell tumor with rhabdomyosarcoma and retroperitoneal metastatic mass: A case report. Urol Case Rep 2021; 34:101475. [PMID: 33294376 DOI: 10.1016/j.eucr.2020.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
A very rare tumor is the combined Mixed Germ cell tumors (GCT) such as testicular non-seminomatouswith somatic malignancy (rhabdomyosarcoma). Here we present a case of a 19-year-old boy with non-seminomatous GCT combined with somatic malignancy (rhabdomyosarcoma) and retroperitoneal mass. The case was managed with radical orchidectomy on the affected side (left side). The patient then admitted for chemotherapy, but unfortunately, he was getting worse and died.
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Chansoon T, Angkathunyakul N, Aroonroch R, Jirasiritham J. Duodenal mature teratoma causing partial intestinal obstruction: A first case report in an adult. World J Clin Cases 2020; 8:1489-1494. [PMID: 32368541 PMCID: PMC7190962 DOI: 10.12998/wjcc.v8.i8.1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A teratoma is a germ cell tumor that is composed of tissue derived from two or three germ layers. Duodenal teratomas are extremely rare and have been exclusively reported in neonates and children. This is the third case of a teratoma primarily arising in the duodenum and the first case that occurred in an adult.
CASE SUMMARY A 31-year-old male presented with clinical partial gut obstruction (epigastric pain, nausea, and vomiting). The physical examination showed a palpable ill-defined mass on the left side of the abdomen. The computed tomography scan revealed a multiseptated cystic tumor at the retroperitoneal area. First, he underwent gastrojejunostomy to relieve the symptoms and was referred to a tertiary-care hospital. The second operation revealed a 10-cm solid-cystic mass originating from the third part of the duodenum and adhering to the abdominal aorta and pancreas. Segmental duodenectomy was performed. The pathological diagnosis was a mature cystic teratoma. The patient was asymptomatic at 5 mo after the operation.
CONCLUSION Duodenal teratomas are extremely rare but should be included in the differential diagnosis in patients who present with intestinal obstruction. Radiological imaging is helpful to reach the preoperative diagnosis. Multidisciplinary team planning is essential to avoid injury to the adjacent organ in duodenal operation.
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Affiliation(s)
- Tharintorn Chansoon
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Napat Angkathunyakul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Rangsima Aroonroch
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Jakrapan Jirasiritham
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Abstract
Discovery of an adrenal mass is nowadays a frequent situation. While adrenal tumors can cause a variety of symptoms, more often than not they are diagnosed incidentally on imaging exams such as CT-scan or MRI performed for another purpose. However, any retroperitoneal supra-renal mass can have an extra-adrenal origin. Indeed, operated non-adrenal masses initially but wrongly diagnosed as an adrenal disease represent about 3.5% of adrenalectomies. These differential diagnoses principally include retroperitoneal tumors that are malignant in two thirds of cases (lymphomas, sarcomas, neurogenic or germinal tumors), and more rarely vascular anomalies or congenital malformations, which are most frequently left-sided due to the wide variety of anatomical structures surrounding the left adrenal gland. Several lesions can originate from the adrenal gland or be located near the gland (paraganglioma, ganglioneuroma). Even though unilateral adrenalectomy is associated with low morbidity, ignorance of these differential diagnoses can cause ill-adapted management; overly conservative surgery in case of sarcoma is one example. Some of these lesions have characteristic clinical or imaging features (cystic lymphangioma, angiomyolipoma…). In other cases, assessment of hormonal secretion is required and additional exams (MRI, percutaneous biopsy, PET-scan with 18-Fluorodeoxyglucose) can correct an erroneous diagnosis. The above diagnostic approach allows appropriate management (with or without surgery). The purpose of this review was to highlight the main differential diagnoses of adrenal masses, to describe their characteristics, and to discuss their therapeutic management.
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Mahmoud S, Salami M, Salman H. A rare serious case of retroperitoneal paraganglioma misdiagnosed as duodenal gastrointestinal stromal tumor: a case report. BMC Surg 2020; 20:49. [PMID: 32178651 PMCID: PMC7077140 DOI: 10.1186/s12893-020-00712-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pheochromocytoma (PCC) and Paraganglioma (PGL) are rare neuroendocrine neoplasms. These tumors harbour disastrous consequences during surgery due to catecholamine hypersecretion if they are undiagnosed or prepared inadequately preoperatively. Case presentation A 41- year- old lady presented with mild left flank discomfort. She had experienced recurrent anxiety attacks accompanied by palpitations and headache which were managed previously as panic attacks. Radiologic investigations showed a retroperitoneal mass that located anteromedial to the left kidney, separated from the left adrenal gland and adherent to the 4th duodenal segment. During admission, her vital signs showed slight elevation of blood pressure (140\90–160\110) mmHg, thus 24-h urine metanephrine and normetanephrine were requested and the results revealed normal values. Upper gastrointestinal endoscopy failed to pass beyond the 3th duodenal segment and showed no pathologic evidence. According to her findings, a diagnosis of duodenal gastrointestinal stromal tumor (GIST) was suspected. During laparotomy, crises of hypertension and tachycardia followed by severe hypotension made the resection of the misdiagnosed mass very tricky. Immunohistochemical staining studies confirmed the diagnosis of paraganglioma. Conclusion Paraganglioma is a life threatening disease and should always be considered as a differential diagnosis of asymptomatic retroperitoneal mass. The aim of our study is to present a challenging case of an undiagnosed retroperitoneal paraganglioma and to alarm our colleagues from such troubles.
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Affiliation(s)
- Schauki Mahmoud
- Department of General Surgery, Albassel Hospital, Tartous, Syrian Arab Republic.
| | - Maissam Salami
- Department of Anaesthesiology, Albassel Hospital, Tartous, Syrian Arab Republic
| | - Hosam Salman
- Department of Histopathology, Albassel Hospital, Tartous, Syrian Arab Republic
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Atkins NK, Stensby JD, Gaballah AH. Lumbosacral plexiform neurofibroma: a rare case in an adult without neurofibromatosis type I. Skeletal Radiol 2020; 49:321-330. [PMID: 31342092 DOI: 10.1007/s00256-019-03281-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/06/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
Plexiform neurofibromas are an uncommon variant of neurofibromas that are described as being essentially pathognomonic of neurofibromatosis type 1 (NF1). Plexiform neurofibromas in the absence of NF1 are extremely rare. We present the case of a 38-year-old woman with a large multilobulated lumbosacral mass extending into the pelvis and proximal thigh. Histopathology of a CT-guided biopsy of the mass revealed it to be a neurofibroma. The imaging findings were consistent with a plexiform subtype. Further imaging and clinical workup showed that the patient had no other identifiable neurofibromas and did not meet criteria for the diagnosis of NF1.
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Affiliation(s)
- Naomi K Atkins
- Department of Radiology, University of Missouri, Columbia, MO, USA.
| | - J Derek Stensby
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri, Columbia, MO, USA
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18
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Taha-Mehlitz SS, Zschokke II, Metzger JJ, Fourie LL. Challenges in the management of life-threatening complications caused by a rare case of sarcoid-lymphoma syndrome. Int J Colorectal Dis 2020; 35:343-346. [PMID: 31832766 DOI: 10.1007/s00384-019-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The sarcoid-lymphoma syndrome is a rare condition where both entities co-exist in the same patient. Overlapping clinical manifestations, imaging findings, and pathological characteristics pose both a diagnostic as well as therapeutic challenge, especially in the setting of life-threatening complications. The objective of this case report is to highlight rare complications caused by abdominal sarcoidosis as well as a subsequently diagnosed non-Hodgkin lymphoma. METHODS A 35-year-old man presented with massive upper gastrointestinal bleeding caused by a large retroperitoneal mass. Following several endoscopic and radiologic interventions, successful hemostasis could only be achieved by an emergency Whipple procedure. Biopsies of the mass showed an abdominal manifestation of sarcoidosis and corticosteroid therapy was started. The patient required several additional emergency surgeries due to a complicated bronchoperitoneal fistula, splenic abscess, perforation of the sigmoid colon, small bowel leakage, and repetitive intra-abdominal bleeding. RESULTS Histopathological findings finally revealed a concurrent lymphoma, as clinically suspected earlier. Ultimately, polychemotherapy was administered. CONCLUSION A concurrent lymphoma can lead to emergency surgery and should be considered when sarcoidosis treatment does not improve symptoms, lymphadenopathy occurs, or hematologic changes persist under therapy.
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Affiliation(s)
- Stephanie S Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.
| | - Irin I Zschokke
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
| | - Jürg J Metzger
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
| | - Lana L Fourie
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
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Ali D, Sarwar MZ, Manzoor F, Naqi SA. Benign idiopathic retroperitoneal cyst: A case series of three patients. Int J Surg Case Rep 2019; 61:210-213. [PMID: 31377546 PMCID: PMC6698274 DOI: 10.1016/j.ijscr.2019.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Retroperitoneal cysts are a rare entity in the field of surgery and their management remains a clinical dilemma for many surgeons. This study addresses the clinical management of three benign retroperitoneal cysts which were presented in our hospital. OBJECTIVES The objective of this case series is to explore the different clinical presentation of the retroperitoneal cyst (RPC). This study also aims at different tools of investigations especially role of CT scan in the diagnosis of RPC and finally the different treatment options available for RPC. METHODS This is a single centered case series of three retroperitoneal cysts which were presented in surgical department of our hospital in the year 2016 and 2017. Total three patients were presented in this case series, two of them were females and one was male. Females were 13 years and 23 years age-old, male was 45 years old. Two of them admitted through the Outdoor Patient Clinic and one was presented to the surgical emergency. Informed consent from the patients and guardian (case1) has been taken. Research work has been reported in line with the PROCESS criteria. RESULTS They were investigated and treated in our hospital. Two of them were diagnosed with retroperitoneal cysts preoperatively and one was diagnosed pre-operatively. In all three cases, surgery had been carried out and they had been observed in their early postoperative period and then followed up for two years. All biopsies had been followed and turned out to be benign idiopathic cysts. These patients have been followed up for 2 years after completion of their treatment. CONCLUSION Retroperitoneal cysts in adults are an uncommon manifestation of abdominal pathology. Their presentation is quite vague. The rarity catches the surgeon off guard at times. Radiology plays a crucial role in defining these lesions and complete surgical excision remains the cornerstone of treatment for symptomatic and complicated patients.
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Affiliation(s)
- Danish Ali
- Lahore General Hospital/ PGMI, Lahore, Pakistan.
| | | | - Fareeha Manzoor
- Mayo Hospital/King Edward Medical University Lahore, Pakistan
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20
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Alghamdi HM. Metastatic testicular retroperitoneal teratoma in an adult: Case report. Int J Surg Case Rep 2019; 60:133-6. [PMID: 31220682 DOI: 10.1016/j.ijscr.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 11/20/2022] Open
Abstract
Differential diagnoses of retroperitoneal masses should remain wide in adults. Teratomas should be considered as a potential cause of abdominal pain and distention in young adults. Testicular examination and past history of any intervention should be sought inn any retroperitoneal masses.
Introduction Teratomas are bizarre neoplasms derived from embryonic tissues typically found in the gonads and sacrococcygeal tissues of adults. Case presentation We report a case of histologically proven metastatic teratoma with an unusual presentation. The 32-year old male patient had a retroperitoneal tumour detected on computed tomography during the workup of abdominal pain. Discussion Retroperitoneal teratomas are uncommon and a challenge to manage. Differential diagnoses could be a dilemma without a thorough history and a high index of suspicion. Conclusions Recurrent metastatic teratoma is one of the rare differential diagnoses of any retroperitoneal mass and can present years after complete resection of the primary tumour.
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21
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Abstract
Castleman's disease is a distinct form of lymph node hyperplasia. It commonly presents as a mediastinal mass and rarely as a solitary retroperitoneal mass. We narrate a case of Castleman's disease presenting as a right suprarenal mass emphasising the usefulness of robot-assisted retroperitoneoscopy in surgical management of retroperitoneal masses in close relation to vital structures.
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Affiliation(s)
- Praveen Sundar
- 1Department of Urology, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala India
| | - Priyank Bijalwan
- 2Division of Uro-oncology, Department of Urology, Amrita Institute of Medical Sciences (AIMS), Ponekkara PO, Kochi, Kerala 682041 India
| | - Ginil Kumar Pooleri
- 2Division of Uro-oncology, Department of Urology, Amrita Institute of Medical Sciences (AIMS), Ponekkara PO, Kochi, Kerala 682041 India
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22
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Rassouli N, Obmann VC, Sandhaus LM, Herrmann KA. (18F)-FDG-PET/MRI of unicentric retroperitoneal Castleman disease in a pediatric patient. Clin Imaging 2018; 50:175-180. [PMID: 29604602 DOI: 10.1016/j.clinimag.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/20/2018] [Accepted: 03/09/2018] [Indexed: 02/08/2023]
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder of unknown etiology that may occur anywhere in the lymphatic system. Imaging plays an important role in detecting and staging this disease. Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) combines the metabolic information derived from nuclear medical imaging with the high soft tissue resolution from MRI. We review the features of CD in standard diagnostic imaging, analyze the specific imaging findings of CD in FDG-PET/MRI and discuss a potential benefit of PET/MRI based on the case of a 15-year-old female patient with retroperitoneal CD.
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Affiliation(s)
- Negin Rassouli
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
| | - Verena C Obmann
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
| | - Linda M Sandhaus
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA.
| | - Karin A Herrmann
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA.
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Grundfest-Broniatowski S, Yan J, Kroh M, Kilim H, Stephenson A. Successful Treatment of an Unusual Case of FPLD2: The Role of Roux-en-Y Gastric Bypass-Case Report and Literature Review. J Gastrointest Surg 2017; 21:739-43. [PMID: 27778252 DOI: 10.1007/s11605-016-3300-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 02/07/2023]
Abstract
Familial partial lipodystrophy type 2 (FPLD2) is a rare disorder associated with LMNA gene mutations. It is usually marked by loss of subcutaneous fat on the limbs and trunk and severe insulin resistance. Scattered reports have indicated that Roux-en-Y bypass helps to control the diabetes mellitus in these patients. We present here a very unusual patient with FPLD2 who had life-threatening retroperitoneal and renal fat accumulation accompanied by bilateral renal cancers. Following cryotherapy of one renal cancer and a contralateral nephrectomy with debulking of the retroperitoneal fat, Roux-en-Y gastric bypass (RYGB) has successfully controlled the disease for 3 years. The clinical presentations and causes of FPLD are reviewed and the role of RYGB is discussed.
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24
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Godkhindi VM, Basade MM, Khan K, Thorat K. Adult Neuroblastoma-Case Report and Literature Review. J Clin Diagn Res 2016; 10:ED01-ED02. [PMID: 28208865 DOI: 10.7860/jcdr/2016/20237.9080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/20/2016] [Indexed: 12/29/2022]
Abstract
Neuroblastoma is the most common solid malignant neoplasm in the paediatric age group; accounting for 7% of all childhood malignancies, but neuroblastoma in adult, is a rare occurrence, finding mention in aeons of medical literature with an overall incidence of 1 in 10 million adults/year. We report the case of a 24-year-old male patient presenting with the complaints of progressive abdominal distention of 2 months duration. Multiple Detector Computed Tomography (MD-CT) of abdomen revealed a huge enhancing mass in the retroperitoneum abutting the left kidney, and a subsequent CT-guided biopsy and immunohistochemistry confirmed the diagnosis of ganglioneuroblastoma. The patient was administered 3-cycles of neo-adjuvant chemotherapy with ifosphamide, carboplatin and etoposide (ICE-chemotherapy) and subsequently 3 more cycles of chemotherapy post surgery, followed by radiation. The rarity of this neoplasm in adults accounts for the lack of standardized staging and treatment protocols and the dismal prognosis even with aggressive multimodal treatment. We report this case because of its extreme rarity, and its tendency for capricious behavior.
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Affiliation(s)
- Vishwapriya Mahadev Godkhindi
- Consultant Pathologist and Haematopathologist, Department of Pathology and Haematopathology, Vedant Multispeciality Hospital , Thane, Maharashtra, India
| | - Maheboob M Basade
- Consultant Oncologist and Head, Department of Oncology, Saifee Hospital , Mumbai, Maharashtra, India
| | - Kamran Khan
- Consultant Oncosurgeon, Department of Oncosurgery, Saifee Hospital , Mumbai, Maharashtra, India
| | - Kiran Thorat
- Consultant Oncopathologist, Department of Pathology, Saifee Hospital , Mumbai, Maharashtra, India
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25
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Maharaj R, Ramcharan W, Maharaj P, Greaves W, Warner WA. Right sided spleen laying retro-duodenal: A case report and review of the literature. Int J Surg Case Rep 2016; 24:37-42. [PMID: 27179335 PMCID: PMC4872470 DOI: 10.1016/j.ijscr.2016.04.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 04/25/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023] Open
Abstract
This is the first reported right accessory spleen laying retro-duodenal reported. This is the second largest accessory spleen reported. Accessory spleen is a possibility in a retroperitoneal tumor differential diagnosis. We present a literature review of the other right accessory spleen cases.
Introduction Unlike left sided accessory spleen that are seen in 10–30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis. Presentation of case We present the case of a patient whose CT scan of the abdomen showed a large mass, 11 × 8 cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher’s incision and immunohistological examination showed that it was a right sided accessory spleen. The patient’s left sided spleen appeared normal. Discussion Efforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration. Conclusion This case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.
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Affiliation(s)
- Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wesley Ramcharan
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Paramanand Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wesley Greaves
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wayne A Warner
- Division of Oncology, Siteman Cancer Center, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Affiliation(s)
- Anand Srivastava
- Senior Advisor (Surgery & Urology), Army Hospital (R&R), Delhi Cantt, India
| | - Amit Agrawal
- Graded Specialist (Surgery & Urology), Army Hospital (R&R), Delhi Cantt, India
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27
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Deger AN, Bayar MA, Caydere M, Deger H, Tayfur M. Retroperitoneal Malignant Peripheral Nerve Sheath Tumour: A Rare Case Report. J Clin Diagn Res 2015; 9:ED09-11. [PMID: 26500915 DOI: 10.7860/jcdr/2015/14169.6481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/27/2015] [Indexed: 11/24/2022]
Abstract
Malignant nerve sheath tumours (MPNST) are rare neoplasias and retroperitoneal cases are fairly rare and clinically difficult to be detected, but they are very agressive neoplasias. MPNST are frequently seen in head, neck and upper extremities. In patients with NF1; MPNST, a poor-prognostic lesion, may result from a malignant degeneration of a former plexiform neurofibroma. It is necessary to be aware of a potential malignancy in patients diagnosed with plexiform neurofibroma. We present a 21-year-old female with a diagnosis of MPNST. The patient was admited to the hospital because of a tumour in the subcutaneous region on her left buttock. The surgeon's clinical diagnosis was lipoma. After the pathological examination of biopsy specimen, the lesion was identified as "plexiform neurofibroma" and then the patient was diagnosed with Neurofibromatosis Type 1 (NF1). Simultaneously, another mass on the retroperitoneal region was identified as malignant peripheral nerve sheath tumour (MPNST).
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Affiliation(s)
- Ayse Nur Deger
- Faculty of Medicine, Department of Pathology, Dumlupinar University , Kutahya/Turkey
| | - Mehmet Akif Bayar
- Faculty, Department of Neurosurgery, Ankara Training and Research Hospital , Ankara/Turkey
| | - Muzaffer Caydere
- Faculty, Department of Pathology, Ankara Training and Research Hospital , Ankara/Turkey
| | - Hakki Deger
- Faculty, Department of Neurosurgery, Kutahya Training and Research Hospital , Kutahya/Turkey
| | - Mahir Tayfur
- Faculty of Medicine, Department of Pathology, Erzincan University , Erzincan/Turkey
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28
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Zhang D, Zhang Y, Liu X, Zhu J, Feng C, Yang C, Wu S, Liu J, Hua Y, Liu F, Zhang N, Zhang Y, He D, Lin T, Wei G. Challenge in preoperative diagnosis of retroperitoneal mucinous cyst in a pediatric patient. Int J Clin Exp Med 2015; 8:19540-19547. [PMID: 26770607 PMCID: PMC4694507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
Mucinous cystic lesions of the retroperitoneum can be either neoplastic or non-neoplastic. It is very important to make a correct diagnosis, or at least, an accurate classification, to proceed with an optimal treatment strategy. In spite of advantage of ultrasound and X-ray image examinations, it is still a challenge to make differential diagnosis of retroperitoneal mucinous cyst from gangliocytoma because both tumors have similar density under the image assessment. In this article, we reported an asymptomatic 8-year-old boy with multiple bronchogenic cysts in both lung and adrenal area on the left side, the latter was considered to be a gangliocytoma preoperatively by ultrasound and computed tomography, but confirmed as bronchogenic cyst by histopathology post laparoscopic resection. The differential diagnosis, imaging features and treatment of bronchogenic cyst are discussed and the relative literatures are reviewed.
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Affiliation(s)
- Deying Zhang
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Yan Zhang
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical UniversityChongqing, China
| | - Xing Liu
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Jin Zhu
- Department of Pathology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Chuan Feng
- Department of Radiology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Chunjiang Yang
- Department of Ultrasonography, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Shengde Wu
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Junhong Liu
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Yi Hua
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Feng Liu
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Nan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of MedicineWinston-Salem, North Carolina, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of MedicineWinston-Salem, North Carolina, USA
| | - Dawei He
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Tao Lin
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
| | - Guanghui Wei
- Department of Urology, Children’s Hospital of Chongqing Medical UniversityChongqing, China
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Verma A, Pandey D, Akhtar A, Arsia A, Singh N. Non-functional paraganglioma of retroperitoneum mimicking pancreatic mass with concurrent urinary bladder paraganglioma: an extremely rare entity. J Clin Diagn Res 2015; 9:XD09-XD11. [PMID: 25859512 DOI: 10.7860/jcdr/2015/11156.5570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/01/2015] [Indexed: 01/23/2023]
Abstract
Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature.
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Affiliation(s)
- Ankur Verma
- Senior Resident, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Diwakar Pandey
- Post graduate Student, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Azaz Akhtar
- Assistant Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Ashish Arsia
- Associate Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Nain Singh
- Associate Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
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Naykı Ü, Naykı C, Uluğ P, Yılmaz I, Cetin Z, Yıldırım Y. A rare case of a giant cystic leiomyoma presenting as a retroperitoneal mass. Iran J Reprod Med 2014; 12:831-4. [PMID: 25709641 PMCID: PMC4330664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/17/2014] [Indexed: 10/27/2022]
Abstract
BACKGROUND Giant retroperitoneal uterine leiomyomas are uncommon. Degenerative changes of a leiomyoma may lead to unusual presentation resulting in misdiagnosis preoperatively. The final diagnosis can be made either intraoperatively or histologically. CASE We report a 45-year-old multiparous women presented with abdominal distension and fatigue for six months. Abdominopelvic Sonography and computed tomography showed a large cystic mass that filled the pelvis and abdomen. With the preoperative diagnosis of a malignant tumor, a laparotomy was planned. Intraoperatively, a cystic mass originated from the uterus near the left side of the broad ligament extending to the retroperitoneal space was observed. Total hysterectomy and bilateral salphingo-oopherectomy was administered. The histology revealed a leiomyoma with cystic degeneration. CONCLUSION Retroperitoneal leiomyomas should be kept in mind in the diferrential diagnosis of a giant cystic mass in abdomen.
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Affiliation(s)
- Ümit Naykı
- Department of Obstetrics and Gynecology, Erzincan University, School of Medicine, Erzincan, Turkey.
| | - Cenk Naykı
- Department of Obstetrics and Gynecology, Erzincan University, School of Medicine, Erzincan, Turkey.
| | - Paşa Uluğ
- Department of Obstetrics and Gynecology, Erzincan University, School of Medicine, Erzincan, Turkey.
| | - Ismayil Yılmaz
- Department of General Surgery, Erzincan University, School of Medicine, Erzincan, Turkey.
| | - Zeliha Cetin
- Department of Pathology, Erzincan University, School of Medicine, Erzincan, Turkey.
| | - Yusuf Yıldırım
- Department of Obstetrics and Gynecology, Erzincan University, School of Medicine, Erzincan, Turkey.
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31
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Hawasli JA, Hopping JR, Hsueh EC. Hypoglycemia with a large retroperitoneal mass - Case report. Int J Surg Case Rep 2014; 5:1225-8. [PMID: 25437682 PMCID: PMC4276271 DOI: 10.1016/j.ijscr.2014.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Retroperitoneal sarcomas have rarely been reported to secrete insulin-growth factor II (IGF-II) and produce an enigmatic hypoglycemia. IGF-II-secreting sarcomas represent an extremely rare subset of soft tissue tumors, and reports are limited to a handful of cases. PRESENTATION OF CASE The authors present the case of hypoglycemia due to an IGF-II-secreting retroperitoneal sarcoma that was successfully treated by complete surgical resection. This report describes the diagnosis and management of this rare syndrome with 1-year follow-up and a review of the literature. DISCUSSION Steroid and growth hormone therapies also have efficacy to treat this hypoglycemia in some patients. However, outcomes appear better if combined with surgical resection. CONCLUSIONS The findings of this case report and review of the literature support a primary role for complete tumor resection to address tumor-induced hypoglycemia.
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Affiliation(s)
- Jennifer A Hawasli
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States.
| | - Jacob R Hopping
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Eddy C Hsueh
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
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Nirhale DS, Bharadwaj RN, Athavale VS, Gupta RK, Bora C. Castleman's Disease-A Rare Diagnosis in the Retroperitoneum. Indian J Surg 2013; 75:9-11. [PMID: 24426496 DOI: 10.1007/s12262-011-0301-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 02/20/2011] [Indexed: 10/18/2022] Open
Abstract
Abdominal masses have always been a dilemma for the surgeons and this problem is more so in retroperitoneal masses. In our case, the patient presented with retroperitoneal mass in the left lumbar region with no other specific local or systemic symptoms. The diagnosis of Castleman's disease was established only after histopathological examination of the mass after resection. Castleman's disease is an angiofollicular lymph node hyperplasia presenting either as a localized or a systemic disease. In our case, the patient presented with the localized form of the disease and as it is a rare presentation we are presenting this case.
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Koktener A, Kosehan D, Akin K, Bozer M. Incidentally found retroperitoneal ganglioneuroma in an adult. Indian J Surg 2014; 77:3-5. [PMID: 25972626 DOI: 10.1007/s12262-013-1030-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 06/08/2010] [Indexed: 11/25/2022] Open
Abstract
The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.
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Affiliation(s)
- Asli Koktener
- Department of Radiology, School of Medicine, Fatih University, Alparslan Turkes Cad. No. 57, Emek, 06510 Ankara, Turkey
| | - Dilek Kosehan
- Department of Radiology, School of Medicine, Fatih University, Alparslan Turkes Cad. No. 57, Emek, 06510 Ankara, Turkey
| | - Kayihan Akin
- Department of Radiology, School of Medicine, Fatih University, Alparslan Turkes Cad. No. 57, Emek, 06510 Ankara, Turkey
| | - Mikdat Bozer
- Department of Surgery, School of Medicine, Fatih University, Ankara, Turkey
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Castillo OA, Landerer E, Vidal-Mora I. Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumours in testicular cancer. Actas Urol Esp 2013; 37:560-4. [PMID: 23643570 DOI: 10.1016/j.acuro.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 01/07/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. OBJECTIVE To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. MATERIAL AND METHODS Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. RESULTS A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. CONCLUSIONS In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumour relapses and increase the survival rate of these patients.
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Affiliation(s)
- O A Castillo
- Departamento de Urología, Clínica Indisa, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile.
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Park SH, Kuh SU, Lim BJ. Retroperitoneal spinal extradural arachnoid cyst combined with congenital hemivertebrae. J Korean Neurosurg Soc 2012; 52:257-60. [PMID: 23115673 PMCID: PMC3483331 DOI: 10.3340/jkns.2012.52.3.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 07/25/2012] [Accepted: 08/29/2012] [Indexed: 12/13/2022] Open
Abstract
Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.
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Affiliation(s)
- Se-Hwan Park
- Department of Neurosurgery, Yonsei University College of Medicine, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Seoul, Korea
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