Retroperitoneal sarcomas: The role of diagnostic imaging and multimodal management

Abstract

Retroperitoneal sarcomas are a varied group of malignancies which have a high rate of recurrence following surgery alone. The majority of the initial recurrences are local in nature, and new therapeutic approaches are clearly needed. Diagnostic imaging and "interventional radiology" have important roles to play in the management of these malignancies, as well as in investigational approaches to therapy. Two cases are presented which illustrate some recent advances in diagnosis and staging of this group of tumors which can be attributed to new cross-sectional imaging techniques, when used in concert with "conventional" imaging methods. The latter include arteriography to guide the placement of intra-arterial catheters for local infusion chemotherapy. CT-guided needle biopsies can be performed to secure a preoperative diagnosis and also to obtain viable tissue for in vitro chemosensitivity assays. A judicious combination of local and systemic chemotherapy, radiation, and surgery may hold promise for better control of this malignancy, similar to the therapeutic advances which have already been obtained with limb sarcomas.

Management of a Catecholamine-Secreting Paraganglioma Requiring Aortic Reconstruction

“…3 The approach to retroperitoneal paragangliomas as with other tumors with retroperitoneal vascular involvement must be well planned and involve appropriate medical and surgical disciplines as required. 5 Extensive preoperative planning is critical to success. Involved vascular anatomy should be well delineated, most commonly with CT scan and/or magnetic resonance imaging (MRI).…”

Jurisdiction Friction and the Frustration of the Hague Convention: Why International Child Abduction Cases Should Be Heard Exclusively by Federal Courts

“…196 When enacting ICARA, Congress emphasized the tradition of leaving family law cases to the expertise of state courts; however, it is important to consider the historical context. 197 At the time ICARA was being drafted, a recent Supreme Court decision 198 limiting the availability of federal jurisdiction over the federal Parental Kidnapping Prevention Act along with sensitivity to giving priority to international custody cases had influenced implementation efforts. 199 Thus, ICARA's grant of concurrent jurisdiction was perceived as a compromise at the time.…”

Tumors at the Aortoiliac/Inferior Vena Cava Bifurcation: Preoperative, Anesthetic, and Intraoperative Considerations

“…1,[4][5][6] The approach to tumors with vascular invasion or encasement must be well planned and multidisciplinary. 7 The possibility of major blood loss must be anticipated and prepared for. In addition to a general surgical oncologist, a vascular surgeon is often required because of the need for vascular resection and reconstruction.…”