Clinical Experience and Management Strategy of Retroperitoneal Tumor With Venous Tumor Thrombus Involvement

Background: To report the surgical management, complications, and outcomes for patients with retroperitoneal tumor and venous thrombus Methods: We retrospectively analyzed 19 cases of retroperitoneal tumor with venous tumor thrombus from August 2015 to March 2021. According to the characteristics of surgical techniques, a new tumor thrombus PUTH grading system was proposed. Results: There were 2 cases of PUTH-1a, 2 cases of PUTH-1b, 6 cases of PUTH-2, 6 cases of PUTH-3,3 cases of PUTH-4. All the operations were successfully performed in 19 patients. Among them, 5 cases (26.3%) were operated by completely laparoscopic approach and 13 cases (68.4%) were operated by open approach. One case (5.3%) was converted from laparoscopic approach to open approach. 5 cases experienced postoperative complications, the incidence was 26.3%. All the cases were followed-up for a median of 14 months. Cancer associated death were occurred in 3 cases. Distant metastases were occurred in 7 cases. Conclusions: In this study, we proposed a new tumor thrombus grading system based on the anatomical characteristics of retroperitoneal tumors with venous tumor thrombus. Retroperitoneal tumor resection and removal of venous tumor thrombus are safe and effective in the treatment of such diseases.

Retroperitoneal paraganglioma with asymptomatic follicular lymphoma : a case report

Paraganglioma (PGL) is a rare tumor originating from extra-adrenal paraganglionic chromaffin tissues, and most sympathetic PGLs have excessive catecholamine secretion. However, non-functional PGLs are sometimes found. Although malignant PGL is defined by metastasis to non-chromaffin tissues, it is difficult to predict malignancies due to the lack of reliable markers of potential malignancies. We report the case of a 69-year-old Japanese woman with an incidental retroperitoneal tumor and multiple enlarged mesenteric lymph nodes simultaneously. There were no subjective symptoms of the patient and no laboratory findings suggesting catecholamine hypersecretion. Both the retroperitoneal tumor and the enlarged mesenteric lymph nodes showed high accumulation of fluorodeoxyglucose (FDG), whereas metaiodobenzylguanidine (MIBG) was accumulated only at the retroperitoneal tumor. Although a retroperitoneal tumor was diagnosed as non-functional PGL by examination including MIBG scintigraphy, the cause of enlarged mesenteric lymph nodes could not be diagnosed by imaging and biochemical tests. As a result of retroperitoneal tumor resection and mesenteric lymph nodes sampling, histopathological examination revealed that a retroperitoneal tumor was PGL and enlarged mesenteric lymph nodes were follicular lymphoma. To reveal an underlying genetic factor, we performed whole exome sequencing of genomic DNA, and we identified two possible candidate variants in SDHD and DLST, but the pathogenicity of these variants remains uncertain in the present case. This rare case reinforces the importance of histopathological diagnosis of non-chromaffin tissue lesions in patients with PGL for the appropriate treatment strategy.

Retroperitoneal tumor of the sympathetic trunk

Sympathogoniomas account for 4.9% of all cases of malignant tumors in children (MV Volkov and MM Brzhezovsky). According to K.A. Moskaleva, sympathogonia were established in 2 out of 36 children who underwent nephrectomy for tumors.

Simultaneous giant adrenocortical and renal cell carcinoma associated with lead exposure from residual gun pellets after shotgun injury: case report

Background A case of simultaneous adrenocortical and renal cell carcinoma due to long-term lead exposure from residual gun pellets is a rare and relatively unknown topic in the literature. Case presentation We present a 43-year-old male patient with a giant retroperitoneal tumor. Thirteen years before he had a shotgun injury of the left upper side of the abdomen and residual gun pellets are present in the abdominal wall. Extirpation of the tumor and the left kidney was performed. Histopathological examination described adrenocortical and renal cell carcinoma. Conclusion Continuous and long-term exposure to toxic lead effects from residual gun pellets and traumatic injury represent likely carcinogenic factors in the presented patient.

LEIOMYOSARCOMA MIMICKING AN ADRENAL GLAND TUMOR

Leiomyosarcoma is a malignant smooth muscle tumor. It is the second most common primary retroperitoneal tumor behind liposarcoma. The retroperitoneal léiomyosarcoma represents 11% of all retroperitoneal malignant tumors. The age of discovery is between 40 and 60 years.

Giant mucinous carcinoma originating from the appendix: A case report

Introduction Appendiceal mucinous neoplasms can involve peritoneal pseudomyxoma or invasion of adjacent organs. This report describes a rare case in which a giant appendiceal mucinous carcinoma expansively developed in the retroperitoneum without perforating the abdominal cavity. Case presentation The patient was a 55-year-old woman with no relevant history who was admitted to our hospital after imaging examinations revealed a retroperitoneal tumor. The clinical diagnosis was a retroperitoneal tumor involving the hedge mucin. The patient underwent right hemicolectomy and partial resection of the duodenum and right abdominal wall to ensure complete tumor resection. Histopathological findings suggested that the tumor was a mucinous carcinoma arising from the appendix. The postoperative course was uneventful. Although adjuvant chemotherapy was performed for 6 months, peritoneal recurrence developed 7 years and 4 months postoperatively. Nine years have passed after surgery and the patient is alive under receiving chemotherapy. Conclusion Detailed pathological examinations revealed that the tumor originated from the appendix. The characteristics of mucinous carcinoma contributed to the extensive growth of the tumor.

Outside the Thorax: Doege–Potter Syndrome Presenting as a Retroperitoneal Abdominal Mass

Objective. We present a case of refractory hypoglycemia, weight loss, and retroperitoneal solitary fibrous tumor. Case report. A 68-year-old female presented with symptomatic hypoglycemia, weight loss, and abdominal mass identified on CT scan of the abdomen. Blood work during symptomatic hypoglycemia was consistent with an IGF-2-producing tumor. The abdominal mass pathology was consistent with solitary fibrous tumor surrounding the adrenal gland, and resection resulted in complete resolution of hypoglycemia. Discussion. Understanding the biochemical mechanisms behind glucose regulation is necessary to diagnose and adequately treat Doege–Potter syndrome, a paraneoplastic syndrome observed in patients with solitary fibrous tumors. Solitary fibrous tumors can be characterized by specific histologic and immunohistochemical studies. Conclusion. This report describes the clinical workup of a patient presenting with hypoglycemia and a retroperitoneal tumor. This case is unique because of its presentation with severe, refractory hypoglycemia and the tumor’s location in the retroperitoneum, given the majority of solitary fibrous tumors are found in the lungs originating from the pleura.