A case of retroperitoneal venous aneurysm]

A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.     

Mucinous adenocarcinoma of the renal pelvis in the horseshoe kidney: a case report

A 41-year-old man with macroscopic hematuria and abdominal fullness was referred to our hospital. Computed tomography (CT) revealed a left renal pelvic tumor in the horseshoe kidney. We performed left heminephrectomy and ureterectomy. The pathological diagnosis was the mucinous adenocarcinoma in the renal pelvis. He received postoperative adjuvant chemotherapy (CAP therapy). He died of retroperitoneal recurrence 8 months postoperatively. In the literature we found 95 cases of primary adenocarcinoma in the renal pelvis including our case.     

Solitary fibrous tumor of the adrenal gland with renal cell carcinoma and angiomyolipoma at the same time; a case report

Solitary fibrous tumor (SFT) is a neoplasm of pleura and its occurrence in the retroperitoneal space is rare. We report a case of SFT of the adrenal gland associated with ipsilateral renal cell carcinoma (RCC) and angiomyolipoma (AML). A 48-year-old woman was referred to our hospital for a left renal AML. Computed tomography (CT) in our hospital showed a left adrenal mass (25 x 20 mm). Because the adrenal tumor was nonfunctioning, she was followed at outpatient clinic. Four years later, CT showed an increase in the left adrenal tumor size (42 x 30 mm) and a left RCC. Left adrenectomy and partial nephrectomy for RCC and AML were simultaneously performed. Histological examination revealed adrenal SFT and clear cell carcinoma and AML of the kidney. We present a brief review on histological characteristics of retroperitoneal SFT and its occurrence in the adrenal grand region.     

Retroperitoneal liposarcoma: a case report

We report a case of retroperitoneal liposarcoma. A 66-year-old male was referred to our hospital for a retroperitoneal tumor that was detected during gallbladder stone examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an extrarenal lipomatous tumor, 20 x 14 x 8 cm in size, in the right retroperitoneal space. He underwent surgical excision of the tumor with concomitant resection of the right kidney and adrenal gland. The resected tissue weighed 730 g. Histological examination revealed a well differentiated liposarcoma. He received no adjuvant therapy.     

Malignant fibrous histiocytoma originating in a renal capsule: a case report]

We report a case of malignant fibrous histiocytoma originating in a renal capsule. A 43-year-old woman was admitted with a chief complaint of right lower abdominal pain. Physical examination was unremarkable. Serum C-reactive protein and erythrocyte sedimentation rate increased to 3.8 mg/dl and 60 mm/hr., respectively. Computed tomography (CT) and magnetic resonance image (MRI) showed a heterogeneous enhanced mass, 4 x 9 x 13 cm in size, in contact with the lateral part of the right kidney. Selective right renal arteriography revealed a hypovascular tumor, the main feeding artery of which was the right adrenal artery. Preoperative clinical diagnosis was a retroperitoneal sarcoma and transabdominal tumor resection was performed. The adhesion between the tumor and the right kidney was so severe that right nephrectomy was also necessary for a radical surgery. The tumor, measuring 13 x 9 x 6 cm, was located laterally adhering to the right renal capsule. Microscopic examination of the tumor demonstrated spindle-shaped fibroblast-like cells arranged in a storiform pattern with fibrous stroma and clusters of rounded histiocyte-like cells and pleomorphic giant cells with bizarre nuclei. Histopathological diagnosis was malignant fibrous histiocytoma arising from the renal capsule and there was no tumor invasion to renal parenchyma. No adjuvant therapy was performed but she has remained well for 31 months since the operation without evidence of disease.     

Surgical removal of retroperitoneal liposarcoma after transarterial embolization: a case report]

A case of retroperitoneal liposarcoma that was removed after transarterial embolization is reported. A 62-year-old man was admitted with body weight loss and general fatigue. Computed tomography revealed an extrarenal tumor, 27 x 17 x 11 cm in size, in the left retroperitoneal space. Arteriography revealed that the hypervascular tumor was fed from the left renal artery, the left adrenal artery and the left lumber arteries (L1-L4). At first the patient underwent transarterial embolization of the left renal artery and the left lumbar arteries (L1, L3, L4). Twenty-two days later he underwent surgical excision of the tumor with combined resection of the left kidney and the descending colon. The resected tissue weighed 2,500 g. Histological examination revealed liposarcoma, pleomorphic type. His postoperative course was uneventful, and he has remained free of disease for 15 months.     

A case of malignant fibrous histiocytoma arising from the renal capsule

A 62-year-old man was admitted with a chief complaint of general malaise. Computed tomography showed a large mass adjacent to the parenchyma of the left kidney. The mass was 17 x 13 x 12 cm in size. Preoperative diagnosis was left renal cell carcinoma and left radical nephrectomy was performed. Histopathologically, the tumor was diagnosed as malignant fibrous histiocytoma (MFH), and the tumor was considered to have arisen from the renal capsule. There has been no recurrence for 7 months postoperatively. We review 40 cases of MFH arising from the kidney or the renal capsule in the literature.     

A case of retroperitoneal malignant peripheral nerve sheath tumor in a patient with neurofibromatosis

We report a case of retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with neurofibromatosis 1. A 42-year-old woman was admitted because of a palpable left abdominal mass. Her mother, son, and daughter had neurofibromatosis 1. Computed tomography and magnetic resonance imaging revealed a 73 x 76 mm retroperitoneal mass. We performed complete resection of the tumor, confirming the margin status by frozen section examination intraoperatively. The histopathological examination revealed MPNST. Although no further therapy was performed, she is alive with no evidence of disease 11 months after surgery.     

A case of leiomyosarcoma of the kidney

Leiomyosarcoma of the left kidney seen in a 58-year-old man is reported. On April 10, 1982, he complained of left flank pain. He visited our hospital and left solitary renal cyst was suspected. He had been treated as an outpatient, but left flank pain became exacervated. On May 18, he was admitted to our hospital. On June 7, radical nephrectomy was done under the diagnosis of left renal cell carcinoma. At operation, the tumor invased directory to the psoas muscle and abdominal wall, and could not be completely resected. Pathological diagnosis was renal cell carcinoma with sarcomatoid change. On July 1, he was discharged from the hospital. In December, left flank distention appeared and back pain became exacervated. On February 8, 1983, he was readmitted to our hospital. Low density area was found in left psoas muscle by CT scanning and recurrence of renal cell carcinoma was suspected. alpha-Interferon therapy had been done, but tumor increased remarkably and caused ileus. He died on June 14, 1983. The autopsy revealed a child head-sized cystic tumor in the upper retroperitoneal space, a 5 X 5 X 5 cm metastasis of the left lobe of the liver, a 3 X 3 X 4 cm tumor to the left upper lobe with cavity formation and direct invasion into the spleen, diaphragma and gastric serosa. These metastatic lesions were leiomyosarcoma. Retrospectively, the primary tumor of kidney revealed primary leiomyosarcoma of kidney.     

Retroperitoneal mixed type liposarcoma: a case report

Primary retroperitoneal tumors are reported to account for 0.2% of all malignancies. Furthermore, 10-20% of all primary retroperitoneal tumors are liposarcomas. Up to 1989, 213 cases of retroperitoneal liposarcoma have been reported in the Japanese literature to our knowledge. Mixed type liposarcomas were rare, and composed 13.8% of all retroperitoneal liposarcomas in this series. We described here a case of retroperitoneal mixed type liposarcoma. A 50-year-old man was admitted to our department with a mass in the left abdomen. Computed tomography and aortography revealed a huge and hypovascular tumor in the retroperitoneal cavity, not containing fat tissue. It was diagnosed as a retroperitoneal tumor and treated surgically. The tumor and the left kidney were encapsulated and could be removed en bloc. The size and weight of the tumor were 28 x 18 x 12 cm and 3,100 g, respectively. Histological examination of the mass proved it to be a mixed type liposarcoma. He was administered OK-432 as adjuvant therapy. After 11 months, bone metastasis to the vertebra appeared. Moreover, lung metastasis also occurred and he died of the disease 15 months after the operation.     

A case of double cancer: renal pelvic transitional cell carcinoma and lung squamous cell carcinoma

A 69-year-old woman was admitted with the chief complaint of gross hematuria and left flank pain ten years after curative right pneumonectomy. Retrograde pyelography showed a filling defect of inferior calyx. Computerized tomography revealed a solid tumor with a low density area arising from the left kidney. The tumor was demonstrated hypovascular by angiography. Left radical nephrectomy by a transabdominal approach was performed. Histological diagnosis was primary transitional cell carcinoma of the left renal pelvis largely replacing the renal parenchyma. Twenty six days after the operation she was discharged. Our case was of double cancer consistent with Warren and Gates criteria and was classified into the nonsimultaneous case according to Moertels criteria. Double cancer of the lung and renal pelvis is very rare and our case seems to be the 7th in the Japanese clinical literature.     

Two cases of ganglioneuroma

Ganglioneuroma is relatively rare, and difficult to distinguish from other tumors due to lack of image findings specific for ganglioneuromas. In this report, two cases of ganglioneuroma preoperatively diagnosed as non-functioning adrenal tumor and retroperitoneal tumor are reported. A 25-year-old male and a 29-year-old male visited our institute with chief complaints of upper abdominal pain and asymptomatic microscopic hematuria, respectively. Computed tomographic scan and magnetic resonance imaging showed a 7 x 6 x 5 cm solid tumor above the upper pole of the right kidney in the former case, 8 cm poorly enhanced tumor grown surrounding the left renal artery in the latter case. Surgical resection was performed in both cases. In the latder case, since intraoperative histological examination showed no malignant finding, renal vessels penetrating in the tumor were preserved by transecting the tumor. Postoperative histological examination revealed an adrenal ganglioneuroma and a retroperitoneal ganglioneuroma in the former and latter cases, respectively. A ganglioneuroma can be surgically dissected with favorable prognosis, but preoperative differential diagnosis is sometimes difficult due to few specific radiological and laboratory findings.     

Retroperitoneal malignant peripheral nerve sheath tumor (MPNST) complicated with von Recklinghausen's disease: a case report

A retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with von Recklinghausen's disease is reported. A 55-year-old woman was admitted with a left side abdominal mass. Physical examination showed numerous cafe-au-lait-spots, subcutaneous masses, scoliosis, and a baby's head-sized fixed mass in the left abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 9 x 9 cm retroperitoneal mass. Two other tumors were also found. One on the left side of the T2-T3 thoracic spine, and the other posterior to the right hip joint. The retroperitoneal tumor was resected en bloc. The tumor was a solid yellow mass. Macroscopically it has a pseudocapsule of fibrous tissue, weighed 1,120 g and measured 9 x 9 x 15 cm. The histopathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Since the responsiveness of these tumors to chemotherapy and radiation therapy is poor, we did not administer adjuvant therapy. The patient is alive with no evidence of recurrence more than 6 months after surgey.     

A case of retroperitoneal fibrosarcoma

A case of retroperitoneal fibrosarcoma is reported. An 81-year-old man was admitted to our hospital with gross hematuria. X-ray examination of intravenous pyelography, computed tomography and angiography revealed left hydronephrosis and left renal tumor. Excisional surgery was carried out. The tumor and left kidney were completely removed. Pathological diagnosis was retroperitoneal fibrosarcoma. Five months later, he died of lung and liver metastasis.     

Malignant fibrous histiocytoma arising from perirenal tissue: a case report

A 79-year-old man who had low grade fever and general malaise was referred to our hospital on January 27, 2004. Physical examination revealed a hard fixed painless mass, measuring 10 cm in the left abdomen. Sarcoma of retroperitoneal origin was suspected preoperatively by abdominal ultrasonogram, CT, MRI and Angiography. Extended surgical treatment including left nephrectomy was performed. The tumor was histologically diagnosed as storiform-pleomorphic malignant fibrous histiocytoma (MFH) arising from perirenal tissue. Although we recommended adjuvant therapy after the excision, the patient refused. After a follow-up period of 11 months, he developed local recurrence in the left retroperitoneal space, and external irradiation was performed. He died 21 months after the operation. To our knowledge, this is the 10th case of MFH arising from perirenal tissue in Japan.     

A case of retroperitoneal teratoma difficult to distinguish from adrenal myelolipoma

A 59-year-old man presented to our hospital suspected of having cholelithiasis. Computed tomography (CT) scan revealed a left retroperitoneal solid tumor cephalad to the kidney, 7 x 8 x 9 cm in size with mostly a fatty density area and focal calcification. Magnetic resonance imaging (MRI) on T1 and T2 weighted images showed a high intensity mass. Angiography revealed the hypovascular tumor. Although we had suspected it to be an adrenal myelolipoma, tumorectomy was performed because of its size. Pathological diagnosis was mature teratoma. Although retroperitoneal teratoma contains fas, cyst, soft tissue and calcification, the proportion of fat in the tumor is usually less than that of adrenal myelolipoma. In our case, the tumor contained more fat than the 'typical' retroperitoneal teratoma, which led to the misdiagnosis.     

Case of retroperitoneal solitary fibrous tumor

Solitary fibrous tumor (SFT) of the retroperitoneal space is rare. We report a case of retroperitoneal tumor, diagnosed as SFT. A 69-year-old woman presented with right lower abdominal swelling, and was referred to our hospital with suspicion of right renal tumor. Abdominal ultrasound and computerized tomography (CT) showed a mass (about 15 x 14 x 10 cm) in the right abdomen. The tumor was thought to be right renal rumor, and right radical nephrectomy was performed. In the excised specimen the tumor was not connected to gastrointestinal tract, peritoneum, or right kidney. The histological and immunohistochemical examination of the specimen revealed SFT. The tumor has malignant potential with partially increased mitotic activity and cellularity in the histological examination. The patient is healthy and without evidence of recurrence or metastasis 26 months from surgery.     

A case of renal cell carcinoma arising in bilateral original kidneys after failure of transplant graft function]

We report a case of renal cell carcinoma arising in bilateral original kidneys after failure of transplant graft function. A 47-year-old man had received a living related renal transplantation on December 10, 1985. He had resumed hemodialysis (HD) therapy because of graft failure on January 8, 1996. Periodic computed tomography (CT), after resumption of HD, revealed multiple cystic change in bilateral original kidneys and a mass in the right kidney. He was referred to our hospital on August 4, 1998 for management of the increased right renal lesion. Abdominal angiography demonstrated a hypervascular and solid mass not only in the right kidney but also in the left kidney. He underwent transperitoneal bilateral nephrectomy. Histopathological examination revealed renal cell carcinoma, bilaterally, with alveolar type and granular cell subtype. He was free of evidence of recurrence and metastasis for 30 months after nephrectomy.     

Retroperitoneal paraganglioma incidentally detected by health examination: a case report

We report a case of non-functioning retroperitoneal paraganglioma detected incidentally by health examination in a 60-year-old female without any clinical manifestation. She was admitted to our hospital for the purpose of evaluation of a renal mass detected by ultrasound sonography. Computed tomography, magnetic resonance imaging and angiography revealed the heterogeneously-enhanced 10 x 10 cm mass in the left retroperitoneal space without any distant metastasis. It was suspected to be a renal cell carcinoma. All laboratory data, including those from endocrinological examinations, were within normal ranges. Radical nephrectomy was performed to resect en bloc the mass and the left kidney. The pathological and immunohistochemical examinations of the mass which was completely separated from the kidney and the adrenal gland, showed characteristic features of paraganglioma with vascular and capsular invasion, with a final clinical diagnosis of the pathologically-malignant non-functioning paraganglioma occurring between the left kidney and the adrenal gland.     

Two cases of retroperitoneal functioning paraganglioma

We report two cases of retroperitoneal functioning paraganglioma. Case 1: A 52-year-old male patient was admitted to our hospital for further examination of pulsating abdominal pain with chest pain and headache. Overfist-size smooth-surfaced hard mass was palpated at the right upper abdominal quadrant. Catecholamine levels in serum and urine showed marked elevation. Computed tomographic (CT) scan, magnetic resonance imaging (MRI) and angiography revealed a large tumor between the right kidney and aorta. He underwent surgical removal of the tumor and histological examination revealed paraganglioma. His chief complaints disappeared postoperatively. Case 2: A 68-year-old female patient was admitted to our hospital for control of diabetes. An abnormal mass was shown ultrasonically at the left renal region by routine screening examination. A marked increase of noradrenaline in serum and urine was observed. Abdominal CT scan, MRI and angiography revealed a retroperitoneal tumor which was located adjoining to the lower pole of the left kidney. The tumor was removed transabdominally. Histopathological studies showed paraganglioma. After the operation her blood sugar and noradrenaline levels decreased to the normal range.