Retroperitoneal Tumor: A Silent Trespasser – Role of Image-Guided Fine-Needle Aspiration Cytology with Histopathological Correlation in Early Diagnosis

Abstract

Objective: Retroperitoneal lesions present a great diagnostic challenge. Here we analyze the spectrum of retroperitoneal lesions and the utility of cytohistopathological correlation in early diagnosis. Study Design: This 7-year study was undertaken in 338 patients with a retroperitoneal mass (kidney/adrenal/ pancreas/retroperitoneal lymph node, or soft tissue origin). In a prospective analysis, 81 patients underwent image-guided fine-needle aspiration cytology (FNAC) and 70 of the 81 underwent Tru-cut biopsy/histopathological evaluation. Clinical, radiological, and pathological details of 257 patients were retrieved from institutional records for retrospective analysis. A total of 119 patients, i.e., 70 in the prospective analysis and 49 in the retrospective analysis, had cytohistopathological correlation. Results: Of the 338 cases, 88.4% were malignant (n = 274), 2.6% were benign (n = 8), 9% were nonneoplastic (n = 28), and 9% were inadequate (n = 28). Most were renal in origin (n = 106; 34.2%), followed by retroperitoneal soft tissue (n = 96; 31%). The most common nonneoplastic lesion was tubercular lymphadenitis (42.85%) and the most common benign lesion was paraganglioma (42.85%). The most common malignancy was renal cell carcinoma (21.16%), followed by Wilms’ tumor (13.86%). In infancy and early childhood, Wilms’ tumor, neuroblastoma, and germ cell tumor were the most common malignancies, while in middle age it was renal cell carcinoma, followed by pancreatic adenocarcinoma, and in the elderly age group it was metastatic carcinoma. Most malignancies were noted in the 5th to 6th decades. The overall sensitivity, specificity, and diagnostic accuracy of image-guided FNAC was 98.02, 72.22, and 94.12%, respectively. Conclusion: Image-guided FNAC is highly sensitive and specific for early diagnosis of an otherwise silent retroperitoneal mass. It saves patient from meticulous surgical procedures for diagnostic reasons and allows more rational planning of management. Knowledge of the distribution of tumors by age group helps to narrow down differential diagnoses.

Perirenal fat metastasis of prostate cancer

“…Das et al reported an overall diagnostic accuracy rate for image-guided FNAC of 94.12％, though 28 inadequate specimens encountered in 338 cases and 37 cases needed repeat aspirations. 2 Perirenal fat mass in our patient was low (17 mm), thus it was considered that an adequate sample might not be fully obtained with a fine needle biopsy procedure and the patient requested a more reliable method of diagnosis. As a result, retroperitoneoscopic tumor resection was chosen, which led to the final diagnosis of prostate cancer.…”

“…Prostate cancer metastasis is most often found in bone, followed by lymph node, liver, and lung tissues. 2 However, to the best of our knowledge, there have been no reports of prostate cancer metastasis to perirenal fat tissue and present the first known case here.…”

Clinical Comparison of Surgical Treatment and Complications in Pediatric Patients with Neuroblastoma at Stage 4

“…Asim et al (9) reported that the sensitivity and speci city of FNAB for the diagnosis of malignant small round cell tumors (SRCT) were 97% and 100%, respectively. Similarly, Das et al (10) indicated that the sensitivity and speci city of FNAB for asymptomatic retroperitoneal masses were 98.02% and 72.22%, respectively. Furthermore, Koshy et al (11) pointed out that FNAB can identify pNT well.…”

Retroperitoneal tumors: Review of diagnosis and management

“…The effectiveness of image‐guided FNAC has also been reported. The overall sensitivity, specificity and diagnostic accuracy of image‐guided FNAC was 98.02%, 72.22% and 94.12%, respectively 33 . However, the results also included epithelial tumors.…”

“…The overall sensitivity, specificity and diagnostic accuracy of image-guided FNAC was 98.02%, 72.22% and 94.12%, respectively. 33 However, the results also included epithelial tumors. Needle biopsy over FNAC is recommended in European Society for Medical Oncology-European Network Reference for Rare Adult Solid Cancers Clinical Practice Guidelines and National Comprehensive Cancer Network Clinical Practice Guidelines.…”