Retroperitoneal Laparoscopic Resolution of Posas Abscess: Case Reports and Review of the Literature.

INTRODUCTION: Psoas abscess is a rare pathological entity being retroperitonescopy an unusual therapeutic modality for its resolution. MATERIALS AND METHODS: The objective is to present and describe five patients with a diagnosis of psoas abscess that were resolved by retroperitoneoscopy in our institution and then carried out a non-systematic review of the literature. RESULTS: The mean age was 58.8 years and 80% were male. All patients had back pain and none had therapeutic resolution with conservative treatment. 60% of the patients had a methicillin sensitive Staphyylococus Aureus. In the follow-up with a mean of 10.2 months, no recurrence was observed. CONCLUSIONS: Early diagnosis of psoas abscess is important for its correct resolution. In our small series of patients, retroperitoneoscopy was an effective treatment.

Management of Residual Disease After First-line Chemotherapy in a Patient With a Nonseminomatous Germ Cell Tumor.

The case An 18-year-old male presented with a one-month history of a nonpainful right testicular enlargement. He had no family history of neoplasia, nor any relevant past medical history. The physical examination was only remarkable for an enlarged right testicle. A testicular ultrasound revealed a 2.5-cm tumor, and serum tumor markers revealed an elevated ß-human chorionic gonadotropin (ß-HCG), 22 mUI/L (normal, < 0.06 mUI/L); elevated alpha-fetoprotein (AFP), 329 ng/mL (normal, 0-9 ng/mL); and normal lactate dehydrogenase (LDH), 135 /L (normal, 179 U/L). A right radical inguinal orchiectomy was performed. Pathological examination revealed a 2.4 cm by 2 cm embryonal carcinoma with tumor invasion into the tunica albuginea. Postsurgical tumor markers obtained 3 weeks after orchiectomy were ß-hCG, 100.5 mUI/L (normal, < 0.06 mUI/L); AFP, 1075 ng/mL (normal, 0-9 ng/mL); and LDH, 180 U/L (normal, 179 U/L). A chest, abdomen, and pelvis CT scan showed a 2.7-cm retroperitoneal lymph node enlargement, without visceral metastasis. Given the presence of node-positive disease with S2 serum markers, the diagnosis of a stage IIIB intermediate risk nonseminomatous germ cell tumor (NSGCT) was determined, and the patient underwent sperm banking. The patient was started on chemotherapy with 4 cycles of BEP (bleomycin, etoposide, and cisplatin), with a favorable tumor marker decline according to the Gustave-Roussy nomogram. After completion of the fourth chemotherapy cycle, serum tumor markers were negative, and 8 weeks after chemotherapy, the follow-up CT showed a 1.6-cm residual retroperitoneal lymph node conglomerate.

Melatonin ameliorates degenerative alterations caused by age in the rat prostate and mitigates high-fat diet damages.

Imbalance of sexual steroids milieu and oxidative stress are often observed during aging and correlated to prostate disorders. Likewise, high-fat intake has been related to prostate damage and tumor development. Melatonin (MLT) is an antioxidant whose secretion decreases in elderly and is also suggested to protect the gland. This study evaluated the impact of a long-term high-fat diet during aging on prostate morphology and antioxidant system of rats and tested the effects of MLT supplementation under these conditions. Male rats were assigned into four groups: control, treated with MLT, high-fat diet and high-fat diet treated with MLT. The high-fat diet was provided from the 24th week of age, MLT from the 48th (100 µg/kg/day) and rats were euthanized at the 62nd week. The high-fat diet increased body weight, retroperitoneal fatness, glycaemia, and circulating estrogen levels. It aggravated the aging effects, leading to epithelial atrophy (∼32% reduction of epithelial height) and collagen fibers increase (83%). MLT alone did not alter biometric and physiological parameters, except for the prostate weight decrease, whereas it alleviated biometric as well as ameliorated acinar atrophy induced by high-lipid intake. Systemic oxidative stress increased, and prostatic glutathione peroxidase activity decreased fivefold with the high-fat diet despite the indole. Regardless of the diet, MLT triggered epithelial desquamation, reduced androgen receptor-positive cells, increased smooth muscle layer thickness (12%), decreased at least 50% corpora amylacea formation, and stimulated prostatic gluthatione-S-transferase activity. In conclusion, MLT partially recovered prostate damage induced by aging and the long-term high-fat diet and ameliorated degenerative prostate alterations.

Whole-body vibration promotes lipid mobilization in hypothalamic obesity rat.

OBJECTIVES: This study aimed to analyze the effect of whole-body vibration (WBV) on metabolic parameters using the monosodium l-glutamate (MSG) model of obesity. METHOD: MSG-obese rats that were exposed to WBV on a vibrating platform with 60 Hz frequency, 2 mm amplitude, three times/week, 10 min/day, during eight weeks (from postnatal day (PN) 80 to PN136). Blood glucose, creatine kinases (CK and CK-MB) and lipid profile through plasma and liver levels of lipids and lipoproteins were evaluated. Morphology and oxidative stress of adipose and hepatic tissues were further evaluated. RESULTS: When performing a WBV exercise, animals showed contrasting metabolic responses. Vibration Control group (CTL-WBV) presented a reduction in CK and liver triacylglycerol, an increase in glucose, lactate, total cholesterol, liver cholesterol, and LDL while MSG Vibration group (MSG-WBV) showed an increase in total triacylglycerol, VLDL, lactate, CK, liver cholesterol, additional liver lipid peroxidation and LDL, total cholesterol and CKMB reduction. CONCLUSION: Even although the MSG is a model of impacting injury, the metabolic demand of WBV exercise was able to induce mobilization of substrates, highlighting the lipid mobilization in obese animals, it should be used as a metabolic rehabilitation tool in patients with metabolic diseases, such as obesity and diabetes.

Biopsia percutánea core con aguja gruesa guiada por tomografía computada en lesiones retroperitoneales: Experiencia de 10 años / CT-guided core biopsy for retroperitoneal lesions. Experience in 136 procedures

Background: CT-guided core biopsy is a widely used diagnostic technique for retroperitoneal lesions. Aim: To evaluate the diagnostic yield and safety of this procedure. Material and Methods: Review of medical records of 136 patients aged 57 ± 16 years (55% males) subjected to core biopsies performed between 2006 and 2016. Procedure images, biopsy reports and patients' medical charts were reviewed. Diagnostic yield was calculated in those patients whose final diagnosis was confirmed using strict criteria for malignancy. Results: A final diagnosis was confirmed in 122/136 patients. Of these, 110 had malignant lesions. The sensitivity and global accuracy of the procedure for malignancy were 93%. In only 4 of 13 benign lesions (31%), a specific diagnosis was obtained with the biopsy. Only minor complications were reported (6 small, self-contained hematomas). There were no major complications. Conclusions: CT-guided core biopsy of retroperitoneal lesions is a safe procedure, with an excellent diagnostic yield.

[CT-guided core biopsy for retroperitoneal lesions. Experience in 136 procedures]. / Biopsia percutánea core con aguja gruesa guiada por tomografía computada en lesiones retroperitoneales: Experiencia de 10 años.

BACKGROUND: CT-guided core biopsy is a widely used diagnostic technique for retroperitoneal lesions. AIM: To evaluate the diagnostic yield and safety of this procedure. MATERIAL AND METHODS: Review of medical records of 136 patients aged 57 ± 16 years (55% males) subjected to core biopsies performed between 2006 and 2016. Procedure images, biopsy reports and patients' medical charts were reviewed. Diagnostic yield was calculated in those patients whose final diagnosis was confirmed using strict criteria for malignancy. RESULTS: A final diagnosis was confirmed in 122/136 patients. Of these, 110 had malignant lesions. The sensitivity and global accuracy of the procedure for malignancy were 93%. In only 4 of 13 benign lesions (31%), a specific diagnosis was obtained with the biopsy. Only minor complications were reported (6 small, self-contained hematomas). There were no major complications. CONCLUSIONS: CT-guided core biopsy of retroperitoneal lesions is a safe procedure, with an excellent diagnostic yield.

Uncommon cause of life-threatening retroperitoneal hemorrhage in a healthy young Hispanic patient: splenic artery aneurysm rupture.

Splenic artery aneurysms (SAA) are a rare life threatening clinical diagnosis. We present a case of a young Hispanic woman with an aneurysm of the middle branch of the splenic artery and active leakage. The defect was embolized with complete resolution of the retroperitoneal bleeding. Physicians should be aware of this rare entity especially when female patients presents complainiing of severe epigastric pain with associated hypovolemic shock.

Retroperitoneal Castleman's disease with colon cancer. A rare association.

Castleman's disease (CD) is a rare disorder of uncertain aetiology characterised by massive proliferation of lymphoid tissue usually localised as mediastinal masses, although abdominal involvement has been reported. Localised forms are usually associated with a good prognosis, but several more aggressive multifocal variants have been observed. Two different histologic subtypes have been described: the hyaline vascular type, more common in unicentric CD and usually asymptomatic, and the plasma cell form. Unicentric CD may be associated with an increased risk of lymphoma, but there was no reported increased risk of other malignancies. A patient with plasma cell subtype unicentric CD localised in retroperitoneum associated with an adenocarcinoma of ileocaecal valve and liver metastasis is reported.

[Retroperitoneal bronchogenic cyst: Report of one case]. / Quiste broncogénico retroperitoneal: Caso clínico.

Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and leiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal and pericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.

Quiste broncogénico retroperitoneal: Caso clínico / Retroperitoneal bronchogenic cyst: Report of one case

Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and íeiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal andpericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.

Ureter retrocava: relato de caso / Retrocaval ureter: a case report

Relata-se o caso de um paciente com ureter retrocava, diagnosticado inicialmente em exame de urografia excretora e confirmado com tomografia computadorizada do abdome. A tomografia computadorizada torna-se necessária não apenas para confirmar a posição do ureter em relação à veiacava inferior, como também para excluir outras doenças que cursam com hidronefrose, pois hidronefrose é o principal achado do ureter retrocava sintomático.

The authors report a case of a patient with retrocaval ureter found out in an excretory urography and confirmed with abdominal computerized tomography. The computerized tomography is necessary to confirm the position of the ureter and to exclude other diseaseswhich are associated with hydronefrosis, the main imaging finding,when there is a symptomatic retrocaval ureter.

Tumor estromal gastrintestinal primário do retroperitônio / Primary gastrointestinal stromal tumor of the retroperitoneum

O tumor estromal gastrintestinal é uma neoplasia mesenquimal incomum que acomete o tubo digestivo. Os exames de imagem, especialmente a tomografia computadorizada, permitem definir alocalização, dimensão do tumor e sua relação com as estruturas vizinhas, embora a avaliação imuno-histoquímica seja sempre necessária para o diagnóstico etiológico. Os autores relatam um caso de tumor estromal gastrintestinal primário do retroperitônio, procurando mostrar os aspectos radiológicos deste tumor, correlacionando seu comportamento com a literatura.

Gastrointestinal stromal tumor is an uncommon mesenchymal neoplasmwhich affect the gastrointestinal tract. Imaging studies, specially computed tomography, allow to determine localization, size and relationship of the tumor to adjacent structures, althoughimmunohistochemistry stains are always necessary to etiological diagnosis. The authors report a case of a primary retroperitoneal gastrointestinal stromal tumor showing its imaging findings and literature correlation.

Association between Erdheim-Chester disease, Hashimoto thyroiditis, and familial thrombocytopenia.

A 28-year-old woman presented with progressive proptosis of the left eye. She had a history of familial thrombocytopenia and Hashimoto thyroiditis. CT of the orbits demonstrated a bilateral diffuse intraconal and extraconal infiltration. Biopsy from the left intraconal area revealed the typical histopathology of xanthogranuloma with a mixture of foamy histiocytes, Touton giant cells, and eosinophils. Systemic examination revealed a mediastinal and retroperitoneal infiltration with a focal lesion in the left kidney. A biopsy of the retroperitoneal area showed histopathology identical to that of the orbital lesion. A review of the literature indicated that the association between non-Langerhans histocytoses and immunologic dysfunctions is not uncommon. We hypothesize that Erdheim-Chester disease may be linked to an abnormal interaction between T-lymphocytes and macrophages similarly to the macrophage activation syndromes.

Hematoma retroperitoneal traumático / Traumatic retroperitoneal hematoma

Se describen diferentes aspectos de esta lesión, tales como su clasificación, incidencia, frecuencia, clínica, diagnóstico, tratamiento, y complicaciones(AU)

Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion.

The authors describe a case of entomophthoromycosis in a previously healthy patient, who presented with an abscess in the right buttock. After surgical drainage it evolved into a retroperitoneal tumor. The patient improved clinically after resection of the mass and ketoconazole treatment. The histopathological analysis showed the Splendore-Hoeppli phenomenon, suggesting Basidiobolus ranarum infection, a zygomycosis generally restricted to the subcutaneous tissue, with rare gastrointestinal involvement.

Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion

Os autores descrevem um caso de entomoftoromicose em paciente previamente saudável, que apresentou abscesso em nádega direita, evoluindo, após drenagem cirúrgica, para tumoração retroperitoneal. Após ressecção da massa, o paciente obteve melhora clínica, em uso de cetoconazol. A análise histopatológica evidenciou fenômeno de Splendore-Hoeppli, sugerindo infecção por Basidiobolus ranarum, uma zigomicose geralmente restrita ao tecido subcutâneo, com raro comprometimento gastrintestinal.

Síndrome de Wünderlich / Wünderlich syndrome

Introducción: El Síndrome de Wünderlich o hemorragia retroperitoneal espontánea es una entidad poco frecuente, su etiología obedece a múltiples causas. Su forma aguda se caracteriza por dolor y tumor lumbar con signos de hemorragia interna (tríada de Lenk). La presentación suele ser brusca, con elevada morbi-mortalidad. Su tratamiento es quirúrgico en la mayoría de los casos.Objetivo: Presentar dos casos de hemorragia retroperitoneal espontánea.Materia y Método: Análisis de historias clínicas.Caso Nº1: masculino, 47 años, con dolor cólico y distensión abdominal de 48 hs. de evolución, con tumoración en fosa ilíaca izquierda (FII) y flanco izquierdo. Se descompensa hemodinámicamente, cirugía de urgencia, nefrectomía y suprarrenalectomía izquierda. Egreso hospitalario al 10º día. Anatomía Patológica: panarteritis nodosa con compromiso necrotizante de una rama de la arteria renal con dilatación aneurismática y ruptura con hematoma retroperitoneal.Caso Nº 2: femenino, 72 años, ingresa con dolor y tumoración en fosa ilíaca de varios días de evolución, con equimosis. Cirugía electiva al 6º día de internación, diagnóstico intraoperatorio de hematoma retroperitoneal espontáneo: drenaje. Egreso hospitalario al 7º día. Anatomía Patológica: hematoma organizado.Conclusión: El síndrome de Wünderlich es una patología de muy baja frecuencia, se encuentra asociado a procesos tumorales renales y autoinmunes. La TAC es el método de elección para su diagnóstico. El diagnóstico precoz disminuye su alta mortalidad.