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2.
Medicine (Baltimore) ; 99(40): e22575, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019471

RESUMO

RATIONALE: Giant intra-abdominal liposarcomas weighing over 20 kg often increase the intra-abdominal pressure (IAP), which has severe effects on the cardiovascular and respiratory systems. Abdominal compartment syndrome is defined typically as the combination of a raised IAP of 20 mm Hg or higher and new onset of organ dysfunction or failure. The anesthetic management and perioperative management are very challenging. PATIENTS CONCERNS: We presented 2 patients with rare giant growing liposarcoma of the abdomen, weighing 21 kg and over 35 kg, respectively. Circulatory management was particularly difficult in the first case, while respiratory management and massive blood loss was very challenging in the second one. DIAGNOSIS: With a computed tomography scan and peritoneal-to-abdominal height ratio measurement, preoperatively the risk of developing intra-abdominal hypertension and abdominal compartment syndrome was recognized early in each patient. The inferior vena cava and right atrium of the first patient was compressed and malformed due to the uplifted diaphragm, while there was severe decreased lung volume and increased airway resistance, because of rare giant retroperitoneal liposarcomas in the second case. Histologic examination revealed dedifferentiated liposarcoma in both cases. INTERVENTIONS: Both of the patients underwent resection surgery with multiple monitoring; transesophageal echocardiography monitoring in the first case and pressure-controlled ventilation volume guaranteed mechanical ventilation mode in both cases. OUTCOMES: Intraoperatively and postoperatively no cardiopulmonary complications in both patients. The first patient was discharged without any complications on postoperative day 10, and the second patient underwent another surgery because of anastomotic leakage resulting from bowel resection. LESSONS: Multiple monitorings, in particular transesophageal echocardiography should be considered in patients with increased IAP due to a giant mass, while an appropriate lung protection ventilation strategy is crucial in these patients.


Assuntos
Hipertensão Intra-Abdominal/fisiopatologia , Lipossarcoma/complicações , Lipossarcoma/cirurgia , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/cirurgia , Adulto , Assistência ao Convalescente , Resistência das Vias Respiratórias/fisiologia , Fístula Anastomótica/cirurgia , Perda Sanguínea Cirúrgica , Sistema Cardiovascular/fisiopatologia , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Lipossarcoma/diagnóstico por imagem , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Respiração Artificial/métodos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Resultado do Tratamento
4.
Tokai J Exp Clin Med ; 45(2): 69-74, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32602104

RESUMO

BACKGROUND: Cancer of unknown primari (CUP) are said to account for 2% of all carcinomas. Here we report a rare case of CUP confined to the retroperitoneum. CASE PRESENTATION: A 51-year-old man consulted a nearby physician for back pain. The malignant tumor could not be denied by MRI, and she was referred to our hospital. CT and MRI revealed uneven enhanced tumor structures protruding into the L2/3 disc. Part of the tumor was continuous with the left iliopsoas muscle. A CT-guided needle biopsy was performed. Histologically, the sheet-like proliferation of atypical cells was observed. Immunohistochemistry showed that atypical cells were positive for cytokeratin AE1&3, CK7, CD10, GATA3, glypican 3, Hep Par 1, carbonic anhydrase 9 (focal), and vimentin (focal) but negative for CK20, CD56, chromogranin A, synaptophysin, TTF1, HMB45, melan A, and PSA. The pathological diagnosis was poorly differentiated carcinoma. However, it was difficult to determine the primary site from the pathological findings. Positron emission tomography (PET) scan showed no distant metastases. He was diagnosed as poorly differentiated cancer localized to the lumbar spine from the retroperitoneum. Paclitaxel plus carboplatin (TC) was started. After completing 3 kr of TC, she was hospitalized urgently due to worsening lumbago. CT and MRI at admission showed an increase in the main lesion and exacerbation of bone invasion. Radiation therapy was given for curative purposes. Eventually, he died seven months after visiting our hospital and five months after starting TC therapy. CONCLUSIONS: CUP has various disease states, and it is necessary to finish the examination immediately and shift to treatment. More effective treatment including immune checkpoint inhibitor for CUP is needed in the future.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/administração & dosagem , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Evolução Fatal , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/tratamento farmacológico , Paclitaxel/administração & dosagem , Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Retroperitoneais/patologia , Tomografia Computadorizada por Raios X
6.
Postgrad Med ; 132(7): 657-661, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32348167

RESUMO

Paragangliomas (PGLs) arise from chromaffin cells of the extra-adrenal sites along the sympathetic and/or the parasympathetic chain. Majority of the PGLs occur in the abdomen. When retroperitoneal PGLs produce symptoms of compression or invasion of adjacent organs, they could be misdiagnosed as a tumor of adjacent organs. Here, we report a rare case of ureteral obstruction caused by an extra-adrenal retroperitoneal PGL that mimicked a ureteral tumor. A 46-year-old female presented with a 2-year history of hypertension. Routine laboratory tests were unremarkable. The computed tomography (CT) scan showed a hypervascular mass located in the left mid-ureteral section. Ureteropyelography revealed left ureteral obstruction at the level of L4 to L5 vertebrae and hydroureteronephrosis. Cystoscopy confirmed left ureteral obstruction. Based on the clinical and imaging findings, a left ureteral tumor was suspected preoperatively. The tumor was completely resected, and the involved segment of the ureter was removed. No significant enlarged lymph nodes were seen in the pelvic cavity and retroperitoneum. A histopathological examination of the tumor confirmed retroperitoneal PGL partly infiltrating the ureter. The patient's blood pressure returned to the normal range postoperatively. Our case demonstrates the importance of considering extra-adrenal PGL in the differential diagnosis of retroperitoneal tumors.


Assuntos
Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Paraganglioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Ureterais/diagnóstico , Obstrução Ureteral/diagnóstico por imagem
7.
Med Oncol ; 37(4): 27, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32166412

RESUMO

Renal cell carcinoma (RCC) local recurrence after radical nephrectomy is uncommon. When feasible, surgical removal remains the primary treatment strategy; nevertheless, local RCC relapse management is controversial, and less invasive procedures may represent an attractive option to achieve oncologic control. The aim of our study was to assess the feasibility, safety, and clinical outcomes of image-guided percutaneous microwave ablation (MWA) for RCC local recurrence in patients initially treated with nephrectomy with curative intent. 10 consecutive patients underwent CT-guided percutaneous MWA of a total of 10 retroperitoneal nodules. Inclusion criteria were: histologically verified retroperitoneal metastases, previous radical nephrectomy, lesion no larger than 3 cm, no other metastatic site elsewhere. All the procedures were performed under moderate sedation choosing the most favorable patient decubitus. If deemed necessary, pneumodissection was induced before ablation. After the antenna placement inside the target lesion, thermal ablation was achieved by maintenance of a power of 100 W for a total time between 2 and 4 min. All patients were observed overnight and discharged the following day if clinically stable. Technical success was obtained in 100% of patients. One patient was re-treated to complete oncologic response with repeat MWA. No major complications were observed. No patients demonstrated local recurrence at a mean follow-up of 26 months. MWA is a safe and effective treatment strategy for loco-regional relapse of RCC following radical nephrectomy. This technique may represent a valuable approach for patients who are not eligible for surgery.


Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Recidiva Local de Neoplasia , Nefrectomia , Neoplasias Retroperitoneais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Estudos Prospectivos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(7): e19170, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049847

RESUMO

RATIONALE: Primary retroperitoneal germ cell tumors are uncommon and especially rare in female patients. However, this type should be included in the differential diagnosis of retroperitoneal tumors that may metastasize from the gonads and be a primary tumor. PATIENT CONCERNS: An abdominal mass was detected in a 38-year-old woman during physical examination, which was accompanied by left renal obstructive hydrops. She was admitted to our institution for further investigation. The patient had no obvious clinical symptoms, and the levels of serum tumor markers did not signifificantly increase. Abdominal noncontrast enhanced and contrast-enhanced computed tomography revealed a retroperitoneal neoplasm that invaded the left ureter, thereby causing left hydronephrosis. DIAGNOSES: Imaging examination characterized the tumor as malignant based on its invasion in the left ureter. Histopathology and immunohistochemistry confifirmed the resected tumor as a dysgerminoma. The primary gonad-derived germ cell tumor was not found in the pelvis; therefore, the patient was fifinally diagnosed with primary retroperitoneal germ cell tumor. INTERVENTIONS: Preoperative examination was completed, and the retroperitoneal mass was resected. OUTCOMES: During the short-term follow-up, no tumor recurrence was detected. LESSONS: Primary retroperitoneal seminoma should be included in the differential diagnosis of primary retroperitoneal tumors in female patients. The primary retroperitoneal seminoma/anaplastic tumor has an obvious occupying effect and can easily invade the surrounding structures. However, surgical resection of such tumors is an optional treatment strategy.


Assuntos
Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Adulto , Feminino , Humanos , Ultrassonografia
9.
Acta Vet Scand ; 62(1): 8, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007092

RESUMO

BACKGROUND: Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic. CASE PRESENTATION: An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure. CONCLUSIONS: To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.


Assuntos
Doenças do Cão/patologia , Neoplasias Retroperitoneais/veterinária , Espaço Retroperitoneal/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Eutanásia Animal , Feminino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X/veterinária
10.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927807

RESUMO

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Idoso , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/patologia , Ganglioneuroma/cirurgia , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Neurofibroma/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Paraganglioma/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
PLoS One ; 15(1): e0227155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923183

RESUMO

In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations.


Assuntos
Neoplasias da Mama/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Alta Energia/métodos , Neoplasias Retroperitoneais/radioterapia , Sarcoma/radioterapia , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Neoplasias da Mama/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Período Intraoperatório , Transferência de Pacientes , Período Pré-Operatório , Dosagem Radioterapêutica , Neoplasias Retroperitoneais/diagnóstico por imagem , Sarcoma/diagnóstico por imagem
12.
Clin Nucl Med ; 45(4): 324-325, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31977477

RESUMO

A 55-year-old woman presented with intermittent fatigue and abdominal pain. Ultrasound and CT scan showed a large heterogeneous mass in the retroperitoneum, suggestive of malignancy. F-FDG PET/CT was performed for staging. PET/CT images showed a hypermetabolic retroperitoneal mass. Endoscopy revealed a mass infiltrating the duodenum. Eventually, the mass was pathologically proved to be malignant melanoma. Further extensive clinical, radiological, and endoscopic investigations proved the retroperitoneum to be the primary site.


Assuntos
Melanoma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos
13.
J Surg Oncol ; 121(1): 75-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273800

RESUMO

BACKGROUND: Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS: Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS: Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS: Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.


Assuntos
Linfonodos/transplante , Linfangioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Linfangioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
14.
Clin Nucl Med ; 45(2): 129-130, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789918

RESUMO

Retroperitoneal liposarcoma is usually large and can press on other organs. We report a case of a 66-year-old woman with a history of retroperitoneal liposarcoma resection who presented to the emergency department with abdominal pain. Ultrasonography revealed a large abdominal mass with renal displacement. Dynamic renal scintigraphy with Tc-DTPA was conducted to evaluate renal function. However, severe impairment of the right kidney function and abnormal tracer accumulation were observed during the examination. SPECT/CT was performed; 2 kidneys were successfully localized, and the recurrence of tumor was correctly detected.


Assuntos
Rim/diagnóstico por imagem , Lipossarcoma/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Humanos , Compostos Radiofarmacêuticos , Pentetato de Tecnécio Tc 99m
15.
Rev. esp. investig. quir ; 23(1): 31-33, 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-191770

RESUMO

Los tumores malignos de vaina neural periférica (MPNST) se observan con mayor frecuencia en pacientes con neurofibromatosis tipo 1 (NF-1), presentando un crecimiento rápido y unas tasas de supervivencia a los 5 años alrededor del 33%. Presentamos el caso de un varón de 17 años afecto de NF-1 con un MPNST retroperitoneal gigante sometido a tratamiento quirúrgico radical, con recidiva tumoral precoz


Malignant peripheral nerve sheath tumors (MPNST) are most frequently in patients with neurofibromatosis type 1 (NF-1), with a rapid growth and 5-years survival rates around 33%. We present the case of a 17 years old male with NF-1 and a giant retroperi-toneal MPNST who undergoes a radical surgical treatment, with early tumor recurrence


Assuntos
Humanos , Masculino , Adolescente , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Neoplasias Retroperitoneais/etiologia , Neurofibromatose 1/complicações , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
16.
BMJ Case Rep ; 12(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796439

RESUMO

Extragastrointestinal stromal tumour (EGIST) occurs outside the gastrointestinal tract and has histopathological and molecular characteristics similar to gastrointestinal stromal tumour (GIST). This tumour is rare and aggressive. A male patient was admitted with anaemia and lower limb oedema. CT scan showed a tumour in the mesentery and retroperitoneum, suspected to be a small bowel GIST. During laparotomy an unresectable mass was found compressing the retroperitoneal structures. Pathology and immunohistochemistry (CD117) confirmed an EGIST. EGIST arises from Cajal-like cells or from pluripotent stem cells outside the gastrointestinal tract. It is aggressive and has a worse prognosis than GIST. Immunohistochemistry is crucial for diagnosis. Surgery aimed at debulking as much of a tumour mass as possible is the cornerstone of treatment. The role of imatinib is not clear. EGIST is rare and has a bad prognosis, and there is no consensus on grading and management. A low threshold of suspicion is crucial for early diagnosis.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias Retroperitoneais/patologia , Idoso , Anemia/etiologia , Evolução Fatal , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Artérias Mesentéricas/patologia , Invasividade Neoplásica , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia
17.
Am J Case Rep ; 20: 1817-1820, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31806861

RESUMO

BACKGROUND Ganglioneuroma is a rare benign sympathetic chain neoplasm which rarely arise from the adrenal gland in adults and exceedingly rare for ganglioneuroma to arise from different origins in the same patient. We present a rare case of retroperitoneal ganglioneuroma concurring with an adrenal ganglioneuroma in an adult patient. CASE REPORT A 17-year-old healthy male underwent computed tomography (CT) scan after road traffic accident where he was found to have a left adrenal homogeneous hypovascular lesion with another retroperitoneal lesion seen within the right para-colic gutter with similar radiological features. Successful surgical resection was obtained, and histological diagnosis of both lesions was benign ganglioneuroma. CONCLUSIONS Adrenal and extra-adrenal ganglioneuroma can, although rare, concur together. Key findings are the similar radiological appearance of the lesions with typical hypovascular progressive pattern of enhancement. Appropriate pre-surgical diagnosis can aid to proper management since ganglioneuroma needs wide surgical resection due to its high chance of recurrence.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Ganglioneuroma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Ganglioneuroma/diagnóstico por imagem , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
19.
Clin Nucl Med ; 44(12): 991-992, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689283

RESUMO

A 48-year-old woman with intermittent lower back pain for 9 months and known retroperitoneal neurofibroma underwent F-NaF PET/CT scan to assess possible bony lesions causing the pain. Incidentally, the images showed elevated NaF activity in the retroperitoneal neurofibroma. In addition, uterine leiomyoma with heterogeneous calcifications revealed increased NaF activity.


Assuntos
Calcinose/complicações , Radioisótopos de Flúor , Leiomioma/complicações , Neurofibroma/metabolismo , Neoplasias Retroperitoneais/metabolismo , Fluoreto de Sódio/metabolismo , Transporte Biológico , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/complicações , Neurofibroma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/diagnóstico por imagem
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