Cystic Retroperitoneal Masses Research Articles

Retained Foetus-in-Fetu or Fetiform Teratoma – A Diagnostic Dilemma and Operative Challenge

Abstract Foetus-in-fetu (FIF) is a condition where one of the twin foetuses is found developing inside the other. Differentiating this condition from fetiform teratoma (FT), in which the teratoma becomes highly differentiated to take a foetus-like appearance, often becomes arduous. Unfamiliarity with the situation and the presence of bone and hair within such lesions can potentially mislead the surgeon to diagnose it as a dermoid cyst erroneously. Suboptimal surgery can complicate things further when it comes to redoing operations and the final histopathological reporting. We report this case of a partially removed cystic retroperitoneal mass in a 14-year-old male, posing a significant surgical challenge due to dense adhesions to the vital retroperitoneal structures, such as common iliac vessels and ureter. We also faced similar diagnostic dilemmas during histopathology due to the tissues removed during the previous surgery. Based on gross and microscopic features, the possibility of a FIF or FT was rendered.

Cystic retroperitoneal metastasis from testicular seminoma, radiologically mimicking as lymphangioma

BackgroundRetroperitoneal nodal metastasis in a primary testicular tumor is not uncommon and usually presents as solid or solid-cystic nodal masses. A completely cystic appearance with fluid attenuation or fluid signal intensity on computed tomography (CT) and magnetic resonance imaging (MRI), respectively, is an uncommon presentation. There are many case reports of different types of cystic retroperitoneal masses; however, to our knowledge, metastatic retroperitoneal cystic masses showing fluid attenuation/fluid signal intensity on CT/ MRI secondary to primary testicular seminoma masquerading as cystic lymphangioma has been rarely reported in the medical literature. Our case report reports a case of a metastatic retroperitoneal cystic mass in a known case of testicular seminoma patient, which was misdiagnosed as cystic lymphangioma initially based on imaging.Case presentationA 55-year-old—patient presented to our hospital with abdominal pain, which was on and off in character. The patient underwent routine ultrasound abdomen, CT and MRI, which revealed multiple cystic lesions in the retroperitoneum. Initially, a provisional diagnosis of cystic lymphangioma was made based on the utterly cystic nature of the lesion and the presence of calcification. However, fine-needle aspiration cytology (FNAC) confirmed the metastatic origin of the lesion and was strengthened by the previous clinical history of orchidectomy.ConclusionThe treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential. Metastasis should also be kept in the differentials in all cystic retroperitoneal masses. Moreover, clinical history and FNAC can assist in making the correct diagnosis.

Imaging findings in Fetus-in-fetu-misdiagnosed commonly as teratoma

Fetus in fetu is a rare condition associated with abnormal embryogenesis in a diamniotic, monochorionic pregnancy, wherein one of the fetus is enclosed within the body of another normally developing fetus. It should be differentiated from a teratoma because of the later’s malignant potential. Here we report a case of 2 months old girl child who presented with complaints of abdominal distension. USG showed a solid cystic retroperitoneal mass resembling an anencephalic fetus. Contrast enhanced Computed tomography (CT) showed similar findings with visualization of bones resembling femur, sacrum and vertebrae. Findings were correlated with MRI and post-op pathology. The preoperative diagnosis of FIF is based on the observation of vertebral column or limbs in a mass on imaging modalities and our case meets the required criteria.

Wilms' tumor may be a rare presentation of ovarian neoplasms in girls

Extrarenal Wilms' tumor is a rare malignant disorder. It represents 0.5-1% of Wilms' tumor. Management for ERWT is challenging regarding its pathological diagnosis, staging, treatment and prognosis. Here we report a 4 years old girl, presented with huge pelvi abdominal mass originating from the left ovary which was seen by radiologic assessment as a large lobulated heterogeneously enhancing mixed solid and cystic retroperitoneal mass away from both kidneys, occupying most of the abdomen with pelvic extension; it was displacing bowel loops and pancreas, measuring 13 x 15 x 16 cm without evidence of enlarged lymphadenopathy. The mass was diagnosed postoperatively as an extrarenal Wilms' tumor proved by immunohistochemical staining for Wilms' Tumor1 (WT1) with the negative reaction for other markers that exclude other diagnostic possibilities. The patient had an aggressive presentation and advanced disease. The diagnosis was difficult due to the lack of specific radiologic stigmata and aberrant origin. She was treated with aggressive chemotherapy to suit the advanced stage of her disease and unfavorable histology pattern.

A Rare Case of Retroperitoneal Isolated Enteric Duplication Cyst with Malignant Transformation

Abstract Introduction/Objective Isolated enteric duplication cysts (IEDC) are rare congenital abnormalities that do not have a communication with the normal intestinal lumen. They are usually recognized before the age of 2 years. They are rarely encountered in adults and very seldom undergo malignant change. These cysts are predominantly located within the abdominal cavity. They histologically demonstrate gastrointestinal mucosal lining and smooth muscle in the wall. Methods We report a case of a 45-year-old African American female who was evaluated for a pain in the left-sided abdomen and pelvis. Magnetic resonance imaging revealed a large multilocular cystic retroperitoneal mass, extending into the left iliac fossa and anteriorly displacing the colon. No other mass lesion was radiologically identified. The main radiologic impression was sarcoma. A biopsy was performed, and a pathologic diagnosis of adenocarcinoma was established with a consideration of primary retroperitoneal mucinous cystadenocarcinoma. An en bloc surgical resection of the retroperitoneal mass with adjacent segment of the descending colon was accomplished. Gross examination revealed an 11 x 5 x 4 cm cystic mass, containing a necrotic fluid and adherent to a 4 cm long segment of descending colon. Microscopically, the mass was lined by neoplastic cells arranged into tubules, villi and glands. Areas of necrosis were present. The wall of the cystic mass showed extensive hyalinized fibrosis and focal invasion. The neoplastic cells had positive immunoreactivity for CK7, CK20 and CDX2, but were negative for PAX8, PR and ER. Desmin immunostain and trichrome special stain highlighted a focus of smooth muscle bundle within the wall of the mass. These findings led to the pathologic diagnosis of adenocarcinoma arising in retroperitoneal IEDC. Conclusion In conclusion, we present this case because of its unusual presentation and location. Recognition of this entity and its rare malignant potential is important as it can pose a diagnostic challenge to pathologists.

Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia

A 71-YEAR-OLD man was admitted to the intensive care unit because of severe bilateral pneumonia resulting from coronavirus disease-2019. His chief complaints were persistent fever, cough, and shortness of breath. Thoracic computed tomography showed bilateral multiple ground-glass opacities. An arterial blood gas analysis demonstrated a low oxygenation index. The patient received high-flow oxygen therapy via a nasal cannula to maintain his oxygen saturation >90%. After receiving supportive care for 2 days, the patient's respiratory function deteriorated further. Endotracheal intubation was performed, but the patient's oxygen saturation remained approximately 70% despite mechanical ventilation with 100% oxygen. Therefore, percutaneous venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Activated partial thromboplastin time was targeted to 60 seconds using a heparin infusion. Progressive hypotension without apparent cause developed 7 days after ECMO was begun. What is the diagnosis? Acute respiratory distress syndrome and profound hypoxemia are the main causes of death in coronavirus disease-2019 pneumonia.1Ruan Q. Yang K. Wang W. et al.Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan.China. Intensive Care Med. 2020; 46: 846-848Crossref PubMed Scopus (2899) Google Scholar Despite the wide use of mechanical ventilation with low-volume, low-pressure, and prone position ventilation strategies, the mortality is still as high as 60% in severe cases.2Yang X. Yu Y. Xu J. et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study.Lancet Respir Med. 2020; 8: 475-481Abstract Full Text Full Text PDF PubMed Scopus (5946) Google Scholar In such situations, ECMO might be a life-saving measure, but it also is associated with hemorrhagic complications.3Henry B.M. COVID-19, ECMO, and lymphopenia: A word of caution.Lancet Respir Med. 2020; 8: e24Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar,4Augoustides J.G. Extracorporeal membrane oxygenation – crucial considerations during the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; 34: 1720-1722Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar In addition, because of a relatively complex management, various complications may occur during ECMO support.5Keller S.P. Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation.Ann Cardiothorac Surg. 2020; 9: 29-41Crossref PubMed Google Scholar,6Hoyler M.M. Flynn B. Iannacone E.M. et al.Clinical management of venoarterial extracorporeal membrane oxygenation.J Cardiothorac Vasc Anesth. 2020; 34: 2776-2792Abstract Full Text Full Text PDF Scopus (14) Google Scholar Abdominal computed tomography revealed a large cystic retroperitoneal mass, with extravasation of contrast consistent with a retroperitoneal hematoma. The patient remained hypotensive despite volume resuscitation with crystalloid and packed red blood cell transfusion. An intravenous infusion of norepinephrine was required to temporize the hypotension, but the serum lactate concentration continued to increase. The right internal iliac artery was occluded successfully in the angiography suite, and his hemodynamics stabilized. After the procedure, he was returned to the intensive care unit. The patient eventually was weaned from mechanical ventilation and was discharged from hospital 76 days after the procedure. Figure 1 The authors have no conflicts of interest to disclose.

Update on MR Imaging of cystic retroperitoneal masses.

This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.

Desmoid-type fibromatosis mimicking cystic retroperitoneal mass: case report and literature review

BackgroundRetroperitoneal desmoid-type fibromatosis (DF) is an uncommon mesenchymal neoplasm presenting as a firm mass with locally aggressive features. It usually manifests as a well-circumscribed or ill-defined, solid mass on cross-sectional imaging. Cystic changes of DF have been described in the literature in association with prolonged medical treatment or abscess formation. However, spontaneous cystic change is rarely reported.Case presentationHere we report the case of a 46-year-old patient with a DF mimicked a large cystic tumor in the retroperitoneum. Ultrasonography and computed tomography were performed in order to search for localizations and characteristics of the cystic tumor. Radiological findings showed an oval cystic mass with a relatively thick wall, measuring 18.3 × 12.3 × 21.5 cm in the left upper abdomen. Laparoscopic spleen-preserving distal pancreatectomy was performed and histopathological examination by immunohistochemical study enabled us to diagnose a DF invading the pancreatic parenchyma. The patient remained asymptomatic during an 8-month follow up period.ConclusionsWe report an extremely rare case of retroperitoneal DF with spontaneous cystic change. DF can manifest as a mainly cystic mass with a thick wall, as in our case, which makes the correct diagnosis difficult. DF should be included in the preoperative differential diagnosis of a cystic retroperitoneal mass, regardless of its rarity.

Secondary retroperitoneal teratoma

Retroperitonal teratomas are rare. We report on a case of a retroperitoneal secondary localisation of a gonadal teratoma in a patient who had developed primary testicular teratoma 12 years previously. The retroperitoneal mass was detected with an abdominal CT requested for the management of a non-specific abdominal pain. CT and MRI examinations showed cystic retroperitoneal masses combined with calcifications and peripheral enhancement. Review of the literature is presented, including the common differential diagnoses to be considered.

Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report

Spontaneous perforation of the bile duct, is a disease in which spontaneous perforation occurs in the wall of the extrahepatic or intrahepatic duct without any traumatic or iatrogenic injury and more often described in neonates. In this report, we present a 38-year-old female patient who underwent surgery due to an intraabdominal cystic mass. The diagnosis of spontaneous rupture of the common bile duct and huge retroperitoneal biloma was made by intraoperative abdominal exploration. The biloma was drained, ruptured portion of the common bile duct was primarily repaired over a T-tube.

Retroperitoneal Hydatid Disease

Localization of hydatid disease in the retroperitoneal space is extremely rare. We reported a recent case with primary retroperitoneal hydatid cyst, the diagnosis of which was established before surgery. In diagnosis of a cystic retroperitoneal mass, fine needle aspiration biopsy would be useful for planning the definitive surgical strategy.

Colonic‐type adenocarcinoma arising in a primary retroperitoneal mature cystic teratoma

A 47-year-old woman who presented with abdominal pain was found to have a 20 cm cystic retroperitoneal mass. Pathology indicated a colonic-type adenocarcinoma arising in a primary retroperitoneal mature cystic teratoma. The adenocarcinoma was predominantly intracystic with focal superficial invasion into the cyst wall but not beyond the teratoma capsule. Immunohistochemistry showed that the adenocarcinoma cells were diffusely positive for cytokeratin 20 (CK20) and caudal-type homeobox transcription factor-2 (CDX2) but negative for CK7, confirming the colonic phenotype. In addition, the adenocarcinoma was seen adjacent to teratomatous colonic-type mucosa with adenomatous change (i.e. adenoma), suggesting that it was probably arising from a colonic-type adenoma within the teratoma. The carcinoma had a higher Ki-67 proliferation index and had a higher percentage of cells stained for p53 than the adjacent adenomatous lesion. To the authors' knowledge this is the first documented case in which a colonic-type adenocarcinoma was seen arising from a precursor lesion (i.e. a colonic-type adenoma in a primary retroperitoneal mature cystic teratoma) and is the second case of intestinal-type adenocarcinoma arising in a primary retroperitoneal mature cystic teratoma.

Lymphangioleiomyomatosis: pulmonary and abdominal findings with pathologic correlation.

Lymphangioleiomyomatosis (LAM) is a rare disease characterized by pulmonary cysts at computed tomography (CT) and proliferation of abnormal smooth muscle cells at lung biopsy. Almost all patients are female, and all have pulmonary cysts at high-resolution CT. Although the presence of cysts may be suggested at conventional CT or chest radiography, high-resolution CT is superior for cyst detection and is essential for diagnosis. The cysts are typically round; in most cases, the cyst wall is barely seen at thin-section CT. They are typically diffusely distributed throughout the central and peripheral lung parenchyma. The lung bases are affected in all patients. Some patients also have increased lung attenuation or a reticular pattern. Expiratory CT shows no air trapping between the cysts, and most of the cysts decrease in size. Pneumothorax, pleural effusion, and chylothorax are complications of LAM. Certain abdominal findings may provide additional corroborative evidence of the diagnosis. Renal angiomyolipomas, the most frequent abdominal lesions, usually manifest as asymptomatic, small, bilateral tumors of fat attenuation in the renal cortex. Lymphangiomas are cystic retroperitoneal masses that occur in up to 20% of patients. Other CT findings are hypo- or hyperattenuating lymph nodes, a dilated thoracic duct, and ascites.

Case report: Massive biliary dilatation mimicking cystic retroperitoneal masses on computed tomography

An unusual case is presented in which a massively dilated common bile duct produced a confusing CT image of multiple cystic areas within the abdominal cavity. Cholangiography and CT-cholangiography were useful in establishing the correct diagnosis. The differential diagnosis of cystic retroperitoneal masses is discussed.

APPLICATION OF A NEW IMAGING MODALITY, THREE DIMENSIONAL CT (3D-CT), TO A CASE OF ADRENAL PSEUDOCYST

A 34-year-old female patient was seen at the hospital because of right flank pain, back pain, and anemia. Abdominal ultrasonography demonstrated a round 10×10cm cystic retroperitoneal mass just behind the right lobe of the liver, superior to the right kidney and to the right of the vena cava. Abdominal CT and MRI confirmed these findings. Cavogram revealed compression of vena cava by the tumor. Right renal angiogram revealed feeding arteries from the adrenal arteries to the tumor. Three dimentional CT image visualized the accurate anatomical relationship between the tumor and surrounding vascular structures. A preoperative diagnosis of adrenal pseudocyst was made, and the lesion was removed surgically on July 21, 1992. The three dimentional anatomical relationship between the tumor and surrounding vascular structure was the same as preoperative determination by 3D-volume CT. Histopathologically the tumor was adrenal pseudocyst. The patient was discharged in a good clinical condition on August 5, 1992. Three dimentional CT imaging was very useful to image anatomical relationship between the tumor and surrounding vascular structure preoperatively.

Estimation of lamellar body phospholipids in fetal sheep lung fluid after high-speed centrifugation or micropore filtration: A comparative study

gestation (see Fig. l), the fetus and intrauterine contents appeared normal but the adnexal mass appeared to have increased slightly to 8 by 8 cm. The patient gave a history of diffuse right-sided tenderness for the preceding 7 days. Ab dominal examination revealed a soft, cystic mass on the right and cephalad to the uterus. The patient was subsequently scheduled for exploratory laparotomy. Cpon entering the abdomen, examination showed the ovaries, uterus, and tubes to be normal. Further palpation revealed a cystic retroperitoneal mass inferior to the right kidney. The retroperitoneal space was entered and the mass was determined to be contiguous to the right kidney. Aspiration of the cyst yielded approximately 150 ml of clear yellow fluid. The left kidney was palpated and appeared normal. The patient did well until the fifth postoperative day, at which time she complained of pressure and vaginal bleeding. Pelvic examination showed the cervix to be fully dilated with bulging membranes. She was delivered of a male infant weighing 500 gm with Apgar scores of 4 at 1 minute and 1 at 5 minutes. The infant subsequently died in the neonatal intensive care unit. Postdelivery intravenous pyelogram and renal ultrasound showed a left kidney of normal appearance. The right kidney appeared intrinsically normal except for caliceal distortion and a tortuous ureter. This was compatible with the diagnosis of a simple cyst of the right kidney. The most common cystic abnormality of the kidney is a simple retention cyst, which may be multiple, solitary, unilateral, or bilateral.’ It is noteworthy that the cysts usually do not become opaque on excretory urography, but may distort the pyelocaliceal system. The cysts usually are unilocular and do not communicate with the renal pelvis except in the event of rupture into the pelvis. The cysts present with variable and nonspecific symptoms and occasionally are detected as abdominal masses or on incidental urographic studies. The treatment of the pregnant patient with adnexal masses is often Estimation of lamellar body phospholipids in fetal sheep lung fluid after high-speed centrifugation or micropore filtration: A comparative study

Retroperitoneal cyst and congenital absence of ipsilateral kidney

The case report of a patient in whom a cystic retroperitoneal mass and the congenital absence of the ipsilateral kidney, ureter, ureteral orifice, and trigone is presented. The embryology and literature are noted. We can find only 2 similar cases in the literature.