Muscular necrosis after retroperitoneal lymphadenectomy

Abstract

A 36-year-old man was admitted to the hospital because of advanced germ cell tumor. The diagnosis of germ cell tumor was proven histologically after radical orchiectomy. Abdominal CT disclosed multiple masses adjacent to the aorta and vena cava. Four courses of chemotherapy consisting of 800 mg carboplatin per day were given. After chemotherapy, contrast-enhanced abdominal CT disclosed multiple masses with a total diameter of 15 x 7.5 x 16 cm adjacent to the aorta and vena cava. The masses extended from the iliac arteries to both renal hilars. The back muscles were unremarkable (Fig. la). Four weeks after the last course of chemotherapy, the patient underwent radical retroperitoneal lymph node dissection with removal of the residual masses. In order to remove these masses extending from both iliac vessels to both renal hilars, the lumbar arteries were ligated on both sides. The pathologic studies showed necrotic tumor and fibrotic changes without evidence of viable tumor.