A Retroperitoneal Mass in an Elderly Woman

Abstract

71-year-old nun living in a convent was seen by her primary physician because of persistent left abdominal flank discomfort during the previous 6 months. This was accompanied by a 15-lb weight loss and left lower extremity weakness, numbness, and pain on ambulation. Except for systemic hypertension, her past medical history was unremarkable. On physical examination, a tender mass was palpated in her left lower abdomen. The pain elicited by palpation radiated to the left hip and groin areas. There was also contracture of the left hip that was painful on straightening. Results of laboratory examinations were within normal limits. Computed tomographic scanning revealed a large enhancing left retroperitoneal soft tissue mass juxtaposed to the left iliac bone that involved the left iliopsoas and the inferior extent of the left psoas muscle (Figure 1). A subsequent computed tomography‐guided fine-needle aspiration biopsy of the retroperitoneal mass was consistent with a malignant neoplasm. The patient was referred to Loyola University Medical Center for surgical management, and the radiologic survey for metastatic lesion was negative. Preoperative embolization of 2 lumbar vessels and a branch of the iliac artery that supplied the tumor was performed. During the surgical resection, the retroperitoneal mass was noted to be closely associated with the left iliacus and left psoas muscles and to be encasing a segment of the left femoral nerve. Except for extrinsic compression, the adjacent visceral organs, including the lumbosacral vertebrae, were not involved by the tumor.