Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know

Czeyda‐Pommersheim, Ferenc; Menias, Christine O.; Boustani, A.; Revzin, Margarita V.

doi:10.1007/s00261-020-02752-8

Cited by 14 publications

(8 citation statements)

References 62 publications

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“…For this reason, giant DDLPSs often present dedifferentiated areas (4,13,28,35). DDLPSs appear as predominantly non-lipomatous neoplasms that are adjacent, inside or encompass a fatty mass (43).…”

Section: Discussionmentioning

confidence: 99%

“…Imaging is crucial in the diagnosis and preoperative management of DDLPSs (9,14,43). All the investigations carried out preoperatively were fundamental for the selection of the correct treatment: the absence of in ltration of large retroperitoneal vessels and the lack of distant metastases led to choosing an aggressive treatment instead of palliation (3,15,17,18,34).…”

Section: Discussionmentioning

confidence: 99%

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R0 Surgical Resection of Giant Dedifferentiated Retroperitoneal Liposarcomas in the COVID era: Nephrectomy or Not Nephrectomy?

Pegoraro

Santangelo

Alfonso

et al. 2022

Preprint

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Background: Retroperitoneal sarcomas (RPS) are rare findings that can grow into large masses without eliciting severe symptoms. Nowadays surgical resection is the only radical therapy, whenever possible. We present two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPS) and underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic, and the latest literature on the topic will be discussed and analyzed. Case Presentation: The patients, who refused to undergo any medical examination during the prior two years due to the COVID pandemic, were admitted to our Institution complaining about weight loss and general abdominal discomfort. In the first case, we observed a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney. The second patient had a similar primitive retroperitoneal giant left neoplasm which didn’t affect the kidney. Given the masses’ characteristics and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and significantly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, thanks to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS. And both patients were addressed with adjuvant chemotherapy. Conclusions: The treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of major organs’ excision or reconstruction (including the kidney) could lead to an easier postoperative course and a better prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. As the COVID pandemic caused limited medicalization of many population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

R0 Surgical Resection of Giant Dedifferentiated Retroperitoneal Liposarcomas in the COVID era: Nephrectomy or Not Nephrectomy?

Pegoraro

Santangelo

Alfonso

et al. 2022

Preprint

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“…El límite posterior del espacio retroperitoneal está representado por los músculos psoas, abdominal transverso, ilíaco y cuadrado lumbar, pero dependiendo de la posición y dimensiones de los tumores, puede estar formado por el diafragma, riñón ipsolateral, uréteres y vasos gonadales. (1,2) La columna vertebral, los músculos paraespinosos, la vena cava inferior (para tumores del lado derecho) y la aorta (para tumores del lado izquierdo) forman los límites mediales, mientras que los laterales están representados por la musculatura abdominal lateral y, dependiendo de la ubicación de los tumores, puede incluir el riñón y el colon. El límite inferior está formado por el músculo iliopsoas, el nervio femoral, los vasos ilíacos o la pared lateral pélvica, mientras que el límite superior del espacio retroperitoneal está representado por el diafragma, el lóbulo hepático derecho, el duodeno, el páncreas o el bazo.…”

Section: Introductionunclassified

“…Este grupo heterogéneo de enfermedades a menudo plantea un desafío diagnóstico para los radiólogos. (1) La implementación de nuevas técnicas de imagen ha extendido el horizonte en el estudio del retroperitoneo, la tomografía computarizada (TC), resonancia magnética (RM) y la ecografía por ultrasonido (US) son ejemplos de estas, que han mejorado nuestro análisis de las diversas patologías que pueden existir a dicho nivel, describiendo los signos y características anatómicas relacionadas a dichas patologías. (2) Entre las más destacadas de las patologías que abarca esta zona anatómica, la fibrosis retroperitoneal es una de las más resaltante, cuyo origen sigue en estudio, pero se teoriza que está relacionado a un cuadro inflamatorio y depósito de tejido fibrótico que afecta a la zona retroperitoneal sobre las cuatro vértebras lumbares inferiores.…”

Section: Introductionunclassified

Common retroperitoneal tumors

Salinas,

Guanuchi

2023

Salud, Ciencia y Tecnología

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Introducción: Los tumores retroperitoneales (TRP), se definen como aquellos tumores sólidos o quísticos, benignos o malignos, que se desarrollan en el espacio retroperitoneal a partir de tejidos como linfático, nervioso, vascular, muscular y conectivo entre otros. Debido a su ubicación se hace complicado pensar en el diagnóstico en muchas ocasiones. Objetivo: caracterizar los tumores retroperitoneales cuya diagnosis permita comprender su frecuencia incidente en morbimortalidad. Métodos: Artículo de revisión bibliográfica, apoyado en metodología documental, mediante bases de datos digitales: Pubmed, SciELO, Springer y Google Académico, por descriptores en Ciencias de la Salud (DeCS), con criterio de inclusión de artículos publicados entre los años 2018-2022, en inglés y español. Resultados: De los 20 artículos seleccionados, el 55% corresponden a reporte de casos, 30% son artículos de revisión, 10% son trabajos originales y un 5% fue una ponencia en un congreso internacional. En cuanto a la distribución mundial por continentes, por procedencia de los estudios el 60% fueron desarrollados en América, un 30% en Asia y el 10% en Europa, encontrando que África y Oceanía no han reportado en el último lustro investigaciones publicadas. Conclusiones: Los TRP son patologías raras, poco frecuentes en el mundo, sobre todo en Latinoamérica, donde a su vez, la literatura científica es poca y limitada. La perspectiva clínica es heterogénea e inespecífica, pudiendo confundirse con otras patologías que se manifiestan generalmente como masas abdominales de gran tamaño; pero, con preservación de órganos, descubiertas en pacientes laboralmente activos, produciendo desafíos en cuanto a diagnósticos y terapéutica para los cirujanos, radiólogos y oncólogos.

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“…However, it must be differentiated from retroperitoneal non-neoplastic pathologies such as Castleman disease, extramedullary erythropoiesis, Erdheim-Chester disease and amyloidosis. Distinguishing these by characteristic imaging findings prevents unnecessary biopsies and surgeries 2 . PRT originates from soft tissues, lymphatics and neural tissue rather than the organs in the region.…”

mentioning

confidence: 99%

Treatment of primary retroperitoneal tumors: Single center experience

ÜNAL,

KARKİN,

VURUŞKAN

et al. 2023

J Cukurova Anesth Surg

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Introduction: The aim of our study is to evaluate the results of patients who underwent surgery due to primary retroperitoneal tumors in order to contribute to the knowledge pool in the literature. Material Method: The data of patients who underwent surgery due to retroperitoneal tumor at Health Sciences University, Adana City Training and Research Hospital between January 2015 and January 2023 were retrospectively scanned. Approximately 54 patients with a clinical diagnosis of PRT were included in the study. Preoperative demographic characteristics of the patients, such as age at diagnosis, gender, number of surgeries for PRT, preoperative biopsy pathology and symptom status, if any, were recorded. All patients underwent computed tomography (CT) imaging with intravenous contrast. The location, size, density and presence of contrast enhancement of PRT in preoperative imaging methods were recorded. Peroperative incision type and duration, need for erythrocyte suspension transfusion, need for organ resection, complications and length of stay in the postoperative period were evaluated. Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. In 12 (22.2%) patients, adjacent organ resection was performed in addition to the mass. The average length of stay of the patients was 6.2±3.1 days. In the postoperative period, one patient required re-operation due to ileus and one patient due to bleeding. Adjuvant therapy was given to 6 (11.1%) patients after surgery. In the final pathology results of the patients, positive surgical margins were detected in 8 (14.3%) patients. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p

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Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know

Cited by 14 publications

References 62 publications

R0 Surgical Resection of Giant Dedifferentiated Retroperitoneal Liposarcomas in the COVID era: Nephrectomy or Not Nephrectomy?

R0 Surgical Resection of Giant Dedifferentiated Retroperitoneal Liposarcomas in the COVID era: Nephrectomy or Not Nephrectomy?

Common retroperitoneal tumors

Treatment of primary retroperitoneal tumors: Single center experience

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