Radiologically guided percutaneous fine-needle aspiration biopsy of pelvic and retroperitoneal masses: a retrospective study of 68 cases

Fine-needle aspiration (FNA) of the pelvis and retroperitoneum (excluding the pancreas, kidney, and adrenal masses) has not achieved its full potential as a diagnostic modality. We reviewed 68 percutaneous, radiologically guided FNAs from these locations to assess the clinical utility and complication rate of this procedure. Satisfactory material was obtained in 66 cases (97.1%), of which 37 were deemed positive (55%), 3 suspicious (4%), 4 atypical (6%), and 22 negative (32%) for malignancy; two cases (3%) were unsatisfactory. Compared to biopsy (36 patients) and clinical information, the sensitivity and specificity of FNA for malignancy were 90.2% and 100%, respectively, yielding a positive predictive value of 100% and a negative predictive value of 86.6%. The four false-negative cases (5.9%) were due to sampling error. One patient had a minor complication (hematoma) from the procedure. We conclude that FNA is the procedure of choice for detecting most malignancies in these two locations.     

Cytologic analyses of spindle-cell lesions of the thorax and retroperitoneum

Thoracic and retroperitoneal spindle-cell lesions represent a diagnostic challenge in the evaluation of fine-needle aspiration (FNA) specimens. The challenge is due to the morphologic similarities and wide variety of different entities with spindle-cell morphology in these two sites. The purpose of this study was to identify criteria helpful in the classification and differential diagnosis of spindle-cell lesions in these two locations. A set of cytologic features was analyzed in 57 thoracic or retroperitoneal spindle-cell lesions. Our results show that pleomorphism and abundant single cells were parameters associated with high-grade tumors in univariate and multivariate analysis, while coarse chromatin pattern was significant only in a univariate analysis. The combination of absence of pleomorphism, rare single cells, tight cluster arrangement, fine chromatin pattern, and absence of macronucleoli was seen only in benign cases. Assessment of background material was helpful in the differential diagnosis and classification. Necrosis was only found in high-grade cases.     

Comparison of laparoscopic and retroperitoneoscopic approaches to the great vessels in a porcine model

Summary

Conventional laparoscopy has not yet been widely adopted for procedures involving the retroperitoneal organs, due to the problems of adequate bowel retraction and the poor access afforded by the position of the root of the mesentery. Developments in retroperitoneal laparoscopy facilitated by balloon dissection have afforded a new minimally invasive approach to the retroperito-neum. We have compared retroperitoneoscopic and laparoscopic approaches to the great vessels in a porcine model.     

腹膜后入踣手术治疗胰腺坏死并感染的安全性及疗效分析

目的 探讨腹膜后入路手术治疗胰腺坏死并感染的方法、安全性及疗效.方法 分析2008年1月至2013年3月9例重症急性胰腺炎（serious acute pancreatitis,SAP）发生胰腺坏死并感染在局麻或者全麻下实施了腹膜后入路胰腺坏死组织清除引流术患者的临床资料.5例经过1次手术,4例经过2次手术;8例首次手术为双侧清除引流,1例为单侧.结果 术后患者全身中毒症状迅速缓解,无任何并发症发生,首次手术时间60～80 min,平均（73±5.7） min,随访期间8例患者症状均完全消失,无复发,1例患者于术后6周死于心肌梗塞.结论 对于重症急性胰腺炎发生胰腺坏死并感染的患者,腹膜后入路行胰腺坏死组织清除引流术是直接、安全、有效、可行的治疗方法.     

复杂肾上腺腹腔镜手术的技术探讨

腹腔镜手术已成为肾上腺外科疾病治疗的金标准,但对于一些复杂肾上腺疾病腹腔镜处理难度较大.一般将巨大肾上腺肿瘤、肾上腺嗜铬细胞瘤、肾上腺恶性肿瘤、双侧肾上腺肿瘤、既往有手术史以及肥胖患者的腹腔镜手术界定为复杂肾上腺手术.这类手术由于病变与周围组织器官解剖关系密切,易造成副损伤,手术难度较大.原则上这类腹腔镜手术可以选择经腹腔和侧位经后腹腔两种途径,但要根据患者的实际情况和术者的经验选择.术中组织解剖要清晰,操作要细致,并熟悉围手术期可能出现的并发症及处理原则,复杂肾上腺手术同样可以达到良好的治疗效果.     

Retroperitoneal varices simulating masses

Retroperitoneal varices in portal hypertension may simulate the appearance of neoplastic masses or adenopathy. Contrast-enhanced CT scans clarify the diagnosis of large vascular channels. Three patients with large retroperitoneal varices demonstrated on CT had confirmation by angiography.     

Concomitant mediastinal and extrarenal retroperitoneal angiomyolipomas in a patient who previously underwent ipsilateral radical nephrectomy

The association of the tuberous sclerosis complex with angiomyolipoma (AML) arising from the retroperitoneum and mediastinum has not been reported in the literature. We present the first case in which a patient presented with a combined retroperitoneal extrarenal and posterior mediastinal AML. Interestingly, the ipsilateral retroperitoneal AML emerged 15 years after radical nephrectomy for the left renal AML.     

Hyaline‐vascular type Castleman’s disease of the pararenal retroperitoneum: Multidetector CT findings

We describe the case of a 40‐year‐old woman who presented with a pararenal hyaline‐vascular type Castleman’s disease that had an arterial supply from the renal artery and a draining vein as showed by multidetector CT. Identification of the renal artery relationship to the feeding vessel of the mass is critical to prevent potential surgical complications.     

IUPU法建立腹膜后腔72例分析

目的 探讨IUPU法(用镜体直接分离建立后腹膜腔的方法)建立腹膜后腔的有效性和安全性.方法 采用IUPU法用镜体直接推赶腹膜后脂肪和腰部肌肉之间的疏松组织建立腹膜后腔72饲.结果 72例腹膜后腔顺利建立,其中71例完成手术,1例因输尿管结石下移改开放手术.用时3～8min,平均5min;无漏气;出血2～4ml;无胸、腹膜及脏器损伤.结论 该方法在直视下进行操作具有方便、快捷、安全、有效、视野清晰等优点,值得推广.     

Fetus in Fetu: a Fetiform Teratoma

Examination of a retroperitoneal fetus in fetu, diagnosed preoperatively, revealed previously unreported histologic findings in the vascular pedicle and membranous capsule that indicated that these structures are not “umbilical cord” or “amnion.” These findings include nervous innervation of both structures and a well-defined lamina elastica interna and vaso vasorum in the artery of the vascular pedicle. Thus, strong support is provided for the theory that many examples of fetus infetu are remarkably complex, well differentiated, highly organized teratomas. Additional arguments that favor the identity of fetus in fetu and teratoma are presented.