The retroperitoneum can host a wide spectrum of pathologies, including a variety of rare benign tumors and malignant neoplasms that can be either primary or metastatic lesions, whose correct diagnosis can be a challenge for the medical team and whose approach is often complex. We present the case of a patient diagnosed in June 2011, as a result of non-specific abdominal symptoms, with a small retroperitoneal mass with cystic appearance, whose affiliation could not be established. The evolution of this tumor was stable during the 3.5 years of clinical, biological and imaging follow-up, until January 2015 when the patient experienced neurological symptoms of lumbar nerve root compression which could have been associated with the increase in size of the retroperitoneal tumor. The therapeutic management was surgical tumor resection, and histopathology was suggestive for a pseudo-cyst, whose etiology remained unspecified. The peculiarity of the case is represented by the long silent evolution of a retroperitoneal mass, in which the association of neurological symptoms have posed problems of differential diagnosis, and in which the tumors etiology and sudden growth in size haven't been elucidated by the histopathological examination, where no cellular structures able to guide the diagnosis were detected. The curative treatment in these cases remains complete surgical resection of the tumor.

Spontaneous perforation of a gastric ulcer is a rare entity and can often be overlooked considering the frequently silent clinical picture. The posterior erosion of the ulcer through the omental bursa in the retroperitoneal space determines local inflammation which, together with the fibrosis of the retroperitoneal tissue facilitates the enclosure of the gastric content. We present the case of a 49-year old patient investigated for pain in the upper abdomen. The endoscopy performed one month before the admission described a retractile area with a central ulcer on the posterior surface of the stomach, adjacent to the lesser curvature. Given the fact that the abdominal x-ray was normal, a CT scan was performed and a voluminous retroperitoneal cystic lesion was discovered. Combining all the preoperative informations the diagnosis was of retroperitoneal abscess by posterior perforation of a gastric ulcer. Surgical intervention was performed, the abscess was evacuated and it’s wall was completely resected; because of local conditions a distal hemigastrectomy with Roux en Y gastro-enteroanastomosis was chosen over gastrorhaphy and omentoplasty.

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological result was a basal cell carcinoma; local excision was the only treatment performed for this malignancy.

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Perianal endometriosis is a rare pathology which occurs mainly in patients with history of vaginal birth associated with an episiotomy scar. We present the case of a 42 year old patient with history of multiple interventions for right perianal fi stula, accusing pain, purulent secretions and bleeding at the site of the interventions. Biopsies collected were specifi c for endometriosis. In the context of the sphincter involvement, which brings a high risk of incontinence, and the hormone-dependent evolution of this pathology, which tends to regress once menopause is reached, a fi stulotomy was made, with subsequent remission of the purulent secretions, but with the persistence of the bleeding from the region during the menstrual cycle.