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Significance and management of local recurrences and limited metastatic disease in the abdomen.

The management of patients with synchronous or metachronous metastatic carcinoma, sarcoma, or melanoma in the abdomen requires a knowledge of the natural history of the disease and of the available treatment options. Patients with advanced malignant disease may be of marginal performance status yet may require large surgical procedures or combined modality therapy; the most challenging therapeutic decisions involve such patients. The authors highlight the role of surgery in selected patients with metastatic or recurrent malignancy as it is practiced at The University of Texas M. D. Anderson Cancer Center.

Abdominal Neoplasms↗

Diagnosis and behavior of juvenile rhabdomyosarcoma.

The main problems in the diagnosis of rhabdomyosarcoma are 1) distinction of undifferentiated examples from other small cell malignancies, especially soft-tissue Ewing's tumor and lymphoma; 2) distinction of spindling examples from fibrosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, polyhistioma, and other sarcomas; 3) recognition of minimal criteria on small samples such as needle biopsy specimens or frozen sections; and 4) recognition of rhabdomyosarcoma in uncommon sites such as bone (mandible), perineum, retroperitoneum, and chest. In 95 pediatric cases diagnosed and treated at Royal Alexandria Hospital for Children--45 after the introduction of combined therapy--minimal diagnostic criteria were assessed. Cross-striations were found in only one third of cases; longitudinal myofibrils were more common and more helpful. There was much overlap between histologic types, and the microscopic patterns had little bearing on prognoses in preadolescent children. Fourteen cases could not be further differentiated ("embryonal sarcoma, probably rhabdomyosarcoma")--nine small-cell tumors; four tumors from genitourinary tract or head for which very small biopsy specimens were available, and one spindling retroperitoneal neoplasm. In all, slight evidence suggested embryonal rhabdomyosarcoma; this evidence included oat-shaped nuclei and, in a few cells, deeply eosinophilic cytoplasm, small elongated processes, or myxoid or alveolar foci--features that exclude lymphoma and Ewing's tumor. In six cases that were originally classified as poorly differentiated or undifferentiated, later material confirmed the presence of rhabdomyosarcoma by showing a predominantly well-differentiated (pleomorphic) or alveolar pattern after therapy. In 14 remaining undifferentiated cases, immunoperoxidase staining with antihuman-myoglobin serum was positive in five. With combined therapy there was 100 per cent survival among patients with paratesticular, limb, and stage I and stage II tumors; considerably improved survival among patients with head and neck, pelvic, and stage III tumors; and 100 per cent mortality among patients with intra-abdominal and stage IV tumors.

Biopsy↗

Mass lesions of the retroperitoneum (excluding specific organs).

The value of computed tomography (CT) in the diagnosis and management of retroperitoneal masses is discussed. Neoplastic, inflammatory, and hemorrhagic conditions are shown. In addition to facilitating the detection of these mass lesions, CT is especially valuable in allowing accurate biopsies and aspiration to be performed and in the follow-up of the patient.

Abscess↗

[Malignant retroperitoneal schwannoma].

We present an uncommon case of retroperitoneal malignant schwannoma diagnosed accidentally. The clinical, diagnostic and therapeutic features are discussed.

Humans↗

[Primary retroperitoneal tumors in adults].

Primary retroperitoneal tumors are rare and most of the time malignant. Because of the large space in which they grow, they are often discovered lately as they are large. CT and MR are the imaging techniques of choice for the primary diagnosis and the follow up of these tumors. Multiplanar reconstructions , signal and density resolution help for the nature diagnosis. The examinations allowed to find associated signs that helps also for the right diagnosis. The purpose of this paper is to answer a serie of questions: Is the mass in the retroperitoneal space? Are they imaging signs that helps for the diagnosis of nature? Are they associated signs that helps for the diagnosis of nature? What are the most common diagnosis? Is there any place for percutaneous biopsies? What is the role of imaging in the follow up? Are there any other processes that can mimic retroperitoneal tumors?

Adrenal Gland Diseases↗

Radiotherapy in malignant teratomas.

Twenty-seven patients with malignant teratoma, 19 of which received radiation, are presented and the radiation response analyzed. Radiotherapy seems most effective in the palliation of undifferentiated (embryonal) teratoma of the gonads and sacrococcygeal region in early childhood. It is less effective, yet useful, in undifferentiated gonadal and sacrococcygeal teratomas of older children and adults, but seems of little value in carcinomatous ovarian dermoids and in malignant mediastinal teratomas.

Adolescent↗

Primary mucinous cystadenoma arising from behind the posterior peritoneum of the descending colon in a child: a case report.

This is the first report of a primary mucinous cystadenoma (MCA) arising from behind the posterior peritoneum of the descending colon in a paediatric patient. A large intra-abdominal cystic lesion was found incidentally during renal ultrasonography in a 14-year-old girl. Imaging studies showed a 13 x 9 x 15 cm homogeneous cystic lesion with mild contrast enhancement of the wall. The cyst appeared to originate from the retroperitoneum, but was separated from the left kidney, ovary, and pancreas. At laparotomy, there was a cyst behind the posterior peritoneum of the descending colon. The cyst was successfully excised, and histopathology showed MCA. Although primary MCA in the retroperitoneum is extremely rare in children, it should be considered in the differential diagnosis of an intra-abdominal cyst, since it needs to be excised to eliminate the risk of infection, recurrence, and malignancy.

Adolescent↗

Angiography for abdominal pediatric tumors.

Angiography is an important investigative device in the diagnosis and staging of liver tumors. With Wilms' tumors that are bilateral, or if there is suspected inferior vena caval involvement, angiography is helpful. Therapeutic embolization can be very effective with hepatic hemangiomas and certain Wilms' tumors.

Abdominal Neoplasms↗