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There have been very few reports on retroperitoneal serous cysts and only 23 cases have been reported in Japan. We report a case of a 47-year-old woman who presented with the complaint of dull pain in her lower abdomen. After careful examination, she was diagnosed to have retroperitoneal serous cyst.
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BACKGROUND: Fibromatosis or desmoid tumor covers a broad spectrum of benign fibrous tissue proliferations. It is characterized by infiltrative growth and a tendency towards recurrence; however, unlike sarcoma, it never metastasizes. CASE PRESENTATION: We report on a case of extraabdominal fibromatosis originating from the retroperitoneal space in a 43-year-old woman. Seven years earlier she had undergone ureterolysis and ureteroureterostomy for ureteral obstruction. Computed tomography revealed a tumor between the iliocostalis and the psoas muscle. Histopathological evaluation revealed uniform proliferation of spindle cells, with a moderate amount of collagen fibers, suggesting extraabdominal fibromatosis (desmoid tumor). The tumor was surgically resected, and since then, the patient has remained asymptomatic without any restrictions of daily living activities and without any signs of tumor recurrence during the two-year follow-up. CONCLUSIONS: Complete resection is the treatment of choice. Adjuvant therapy using non steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for unresectable or recurrent cases.
The reported case is characterized by the original tumor site as well as by the recurrence site; by the slowly evolutive nature of the lesion over nine years from the time of surgical tumor excision to relapse; and by histological variations raising a nosological problem. Our clinical, anatomopathological and therapeutical observations are based on the characteristics of the case as well as published data. We only traced 5 cases in the literature of spermatic cord tumors with retroperitoneal localization. The progressive histologic polymorphism of these tumors compels us to raise the question of the very nature of this neoplasm: liposarcoma or malignant mesenchymoma. The potential clinical and histologic outcome of mesenchymal tumors of the spermatic cord cause us to propose direct orchidectomy and surveillance of the retroperitoneal space throughout the evolution of the process, even far off into the future.
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Solitary fibrous tumors (SFTs) are spindle-cell neoplasms originally described in the pleura. It is now known that these tumors can develop in many sites. This report describes the case of a well-circumscribed tumor located around the superior mesenteric artery (SMA), which was initially thought to be either a superior SMA aneurysm, a lymphoma, or a neurogenic tumor. Histological examination demonstrated the tumor to be composed of a cellular proliferation of ovoid to spindle cells with a fine collagenous matrix in the short fascicles. Immunohistochemical staining was strongly positive for CD34 and negative for factor VIII, cytokeratin, desmin, and muscle-specific actin (HHF-35). These findings suggested a diagnosis of SFT in the retroperitoneal space. To our knowledge, this is the first report of an SFT located around the SMA. Based on the above findings, it is important to include SFT in the differential diagnosis of retroperitoneal tumors located around the SMA.
Hemangiopericytoma is a rare capillary tumor that was first described and named by Stout and Murray in 1942. A case of hemangiopericytoma in the pelvic retroperitoneum is reported. The patient, a 57 year old man, was admitted because of dysuria. He underwent extirpation of the tumor with the rectum by low anterior resection. The pathological diagnosis was malignant hemangiopericytoma, and Adriamycin was administered to prevent recurrence or metastasis. He has been free from any recurrence or metastasis for the last eight months. Twenty cases of hemangiopericytoma in the retroperitoneum including our case, were collected from Japanese literature and reviews. Hemangiopericytoma, especially in the retroperitoneal space, should be regarded as a highly malignant tumor. Early aggressive therapy and long term follow up are recommended because the tumor characteristically produces late local recurrence and metastasis.
The purpose of this study was to evaluate the safety and precision of MRI-guided biopsies of retroperitoneal space-occupying tumors in an open low-field system. In 30 patients with indistinct retroperitoneal tumors [paraaortic lesion (n=20), kidney (n=2), suprarenal gland (n=3) and pancreas (n=5)] MR-guided biopsies were performed using a low-field system (0.2 T, Magnetom Concerto, Siemens, Germany). For the monitoring of the biopsies T1-weighted FLASH sequences (TR/TE=160/5 ms; 90 degrees ) were used in all patients and modified FLASH sequences (TR/TE=160/13 ms; 90 degrees ) in ten patients. After positioning of the needle in the tumors 114 biopsy specimens were acquired in coaxial technique with 16-gauge cutting needles (Somatex, Germany). The biopsies were successfully performed in all patients without vascular or organ injuries. The visualization of the aortic blood flow with MRI facilitated the biopsy procedures of paraaortic lesions. The size of the lesions ranged from 1.6 to 7.5 cm. The median distance of the biopsy access path was 10.4 cm. Adequate specimens were obtained in 28 cases (93.3%) resulting in a correct histological classification of 27 lesions (90%). In conclusion, MR-guided biopsies of retroperitoneal lesions using an open low-field system can be performed safely and accurately and is an alternative to CT-guided biopsies.
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A complex study of 106 patients included plain abdominal and retroperitoneal X-rays, pneumoretroperitoneum examination, angiography and contrast X-ray of the gastrointestinal tract. Retroperitoneal pathology was detected in 94.3% of cases. In 90.5%, neoplastic lesions were diagnosed and their tissue origin established. The said complex of X-ray procedures may detect secondary changes in adjacent organs, tissues and major blood vessels which is instrumental in the choice of optimal treatment modality.
A CT-guided fine-needle puncture was performed in 42 patients with renal or retroperitoneal space-occupying growths identified by means of computed tomography. In 18 out of 24 patients (75%), CT-guided fine-needle puncture enabled verification of malignant neoplasias, relapses and metastases by means of identification of malignant cells. In 9 out of 13 patients suspected of retroperitoneal abscess, fine-needle puncture helped to establish the diagnosis by a positive bacteriological finding. In 5 cases, CT-guided anterograde pyelography and percutaneous nephrostomy were effected after puncture of the renal pelvis by means of sonography had failed. CT-guided puncture should be used as an additional or complementary examination over and above computed tomography alone whenever a space-occupying growth is present the aetiology of which remains unclear. CT-guided puncture is indicated on principle in retroperitoneal space-occupying growths which cannot be properly defined by sonography.
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