Retroperitoneal Tumors Preoperatively Misdiagnosed as Adrenal Tumor

ABSTRACT

PURPOSE: Despite of recent advances in the resolution of computed tomography (CT) and magnetic resonance imaging (MRI), there are different kinds of peri-adrenal retroperitoneal tumors that can hardly be differentiated from adrenal tumor preoperatively. By reviewing certain tumors and their characteristics, we may increase the preoperative diagnostic accuracy and so may perform the proper operation when facing this situation. METHODS: We retrospectively reviewed fourteen cases of non-adrenal origin retroperitoneal tumors that were preoperatively diagnosed as adrenal tumors during a seven-year period at Seoul National Universiry Hospital. RESULTS: The fourteen retroperitoneal tumors preoperatively misdiagnosed as adrenal tumors were extra-adrenal ganglioneuroma (6 cases), schwannoma (2 cases), retroperitoneal paraganglioma (1 case), bronchogenic cyst (2 cases), Castleman's disease (1 case), idiopathic retroperitoneal fibrosis (1 case) and leiomyosarcoma (1 case). All of them were large (> 6 cm), and most were solid. CONCLUSION: For the correct preoperative diagnosis and appropriate operation of peri-adrenal retroperitoneal tumors, and especially when the tumors are large and solid, the disease entities mentioned above should be excluded, and the application of additional diagnostic measures such as preoperative fine needle aspiration cytologic examination or biopsy, endoscopic ultrasound (EUS), intraoperative frozen biopsy, laparoscopic ultrasound (LUS), as well as preoperative CT and MRI, should be considered when the diagnosis is not conclusive.