Perirenal venous aneurysm presenting as retroperitoneal tumor treated successfully by laparoscopic excision

We describe an unusually located venous aneurysm found incidentally in a 46-year-old man that was presumptively diagnosed as a retroperitoneal mass near the left renal hilum. He presented for constipation and weight loss; an abdominal ultrasound scan disclosed an anechoic lesion in the left retroperitoneum. Abdominal CT showed a 3-cm mass with low density located at the junction of the left para-aortic and perirenal hilar regions that was initially suspected of being metastatic lymphadenopathy with an unknown primary origin or a neurogenic tumor. The mass was resected by a laparoscopic approach, which revealed a round mass with a smooth capsule and roots connecting to the paraspinal muscles. On pathologic examination, the mass showed classic features of a venous aneurysm. At 12-month follow-up, no local recurrence or malignancy was documented.     

A case of retroperitoneal mucinous cystadenoma of borderline malignancy

Surgical experience of a rare case of malignant retroperitoneal cyst is reported. A 41-year-old female was admitted on Feb. 26, 1986, complaining of left lower abdominal tumor and mild abdominal pain. She underwent complete removal of an abdominal tumor located at the left flank lateral to the sigmoid colon on March 5. The tumor was well encapsulated, cystic and oval, 12 X 10 X 9 cm in size. Histologic feature of the tumor is classified as mucinous cystadenoma of low grade malignancy by WHO classification.     

Primary retroperitoneal mucinous cystadenoma

Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. However, Primary retroperitoneal mucinous cystadenomas (PRMCs) are very rare. We present a 50-year-old woman referred to our institution with history of intermittent abdominal pain and palpable mass in her left flank. On CT-scan an unilocular cystic mass with thin wall measuring 171 × 155 × 108 mm in the retroperitoneum was shown. Patient underwent surgical excision of the tumor. The histopathology examination showed a cystic mass with a fibrous wall and an epithelium composed of a single layer of columnar cells with mucin vacuoles compatible with PRMC.     

A case of retroperitoneal lymphangioma successfully treated by pancreatoduodenectomy

A rare case of retroperitoneal lymphangioma in 44-year-old male complaining of high fever and right hypochondralgia is reported. Retroperitoneal malignant tumor was suspected preoperatively, and pancreatoduodenectomy was performed because the tumor infiltrated to duodenum and head of the pancreas. Histopathological examination revealed that the tumor was lymphangioma infiltrating to the duodenum. There are two types of lymphangioma, solitary lymphatic cyst and true proliferating lymphangioma and in this case, the tumor is diagnosed as true proliferating lymphangioma which is cavernous and infiltrating.     

Total excision of mucinous biliary cystadenoma

In the past year, total excision of mucinous biliary cystadenomas was carried out in three patients by shelling these lesions out from the liver substances. Formal hepatic resection was unnecessary. As any previous surgical procedure on the cyst will make subsequent excision technically more difficult, or even impossible, it is believed that excision should be carried out at the initial operation. Thus, a correct pre-operative or intra-operative diagnosis is important. This requires a high index of clinical suspicion, an adequate pre-operative work-up and an appropriate use of intra-operative ultrasound and frozen section to differentiate these lesions from other cystic lesions of the liver.     

A case of retroperitoneal bronchogenic cyst treated by laparoscopic surgery

We describe herein a rare case of a retroperitoneal bronchogenic cyst successfully treated by laparoscopic surgery. A 39-year-old man with low-grade fever was referred to our hospital because of suspicion of an adrenal tumor. Abdominal computerized tomography (CT) and ultrasonography revealed a homogenous solid mass, 35 x 30 mm in diameter, in the left suprarenal region. Laboratory studies showed that the levels of adrenal hormones were normal except for the white blood cell count of 9,700/microL and C-reactive protein of 1.7 mg/dl. We diagnosed it as a non-functioning adrenocortical adenoma or an adrenal cyst. However, one year later he underwent laparoscopic surgery because the mass had gradually increased by 10 mm and the low-grade fever persisted. Pathological evaluation of the surgical specimens established the diagnosis of retroperitoneal bronchogenic cyst. The low-grade fever disappeared after the surgery.     

Primary retroperitoneal mucinous cystadenoma. A case report and brief review of the literature

Retroperitoneal mucinous cystadenomas are extremely rare tumors found exclusively in women. An additional case of retroperitoneal mucinous cystadenoma histologically confirmed in a 41-year- old woman is reported herein. Computed tomographic (CT) scanning showed a cystic mass, 21 x 16 cm in size, in the right retroperitoneal space. Removal of the cystic tumor was performed without any other additional procedures, and further histological diagnosis was confirmed as primary mucinous cystadenoma of borderline type. Histologic findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium. Clinicopathological features, diagnostic findings, therapeutic options and the outcome are analyzed in this paper having reviewed the cases reported in world literature.     

Total laparoscopic excision of retroperitoneal ganglioneuroma: A case report

IntroductionGanglioneuromas are rare benign tumors originating from neural crests and typically affect young adults. The most frequent locations are the posterior mediastinum, retroperitoneum and adrenal gland. In general, retroperitoneal ganglioneuromas are discovered incidentally or by mass effect. In the literature, the number of retroperitoneal masses reported is quite limited. We report a case of laparoscopic excision of a retroperitoneal ganglioneuroma.Presentation of caseThe patient was a 40-year-old woman who visited a nearby clinic with anorexia and vomiting. She was referred to our hospital after the detection of an abdominal mass.Enhanced computed tomography(CT) showed a lobule mass of 107 × 42 mm in size, with internal inhomogeneity and mild delayed enhancement on the retroperitoneal side of the left abdominal lesion. Magnetic resonance imaging(MRI) showed a mass with low intensity and partial high intensity on T2 weighted Image (T2WI). In addition, positron emission tomography CT(PET-CT) detected slight fluorodeoxyglucose (FDG) accumulation (standardized uptake value(SUV) max: 3.01) in the same lesion. Based on these findings, we suspected a retroperitoneal tumor. Laparoscopic excision was performed via 5 ports. The extracted tissue was a well-defined mass of 110 × 70 mm. The tumor in our case exceeded 10 cm.The pathological diagnosis was ganglioneuroma, with no obvious malignancy.DiscussionIt was suggested that adaptation of laparoscopic surgery should be considered based on the observation of organ invasion or vessel invasion and adhesion around the tumor, rather than based on the diameter of the tumor.ConclusionThis approach is less invasive than conventional laparotomy methods and achieves good cosmetic outcomes. Thus, totally laparoscopic procedures should be considered more often for the treatment of retroperitoneal tumors.     

Laparoscopic resection of a primary retroperitoneal mucinous cystadenoma: Report of a case

(Received for publication on July 4, 1996; accepted on Mar. 4, 1997)     

A case of retroperitoneal mucinous cystadenocarcinoma

A 61-year-old woman was admitted to our hospital for right abdominal mass. Various examinations revealed a retroperitoneal tumor. Open surgery was performed. Pathological findings revealed a mucinous cystadenocarcinoma. We review and discuss 24 cases of retroperitoneal mucinous cystadenocarcinoma reported in Japan.     

A case of multiloculated retroperitoneal abscess successfully treated by percutaneous drainage with a Malecot catheter

Percutaneous catheter drainage offers an attractive alternative to open surgical drainage as the first choice in the treatment of retroperitoneal abscess. However, multiloculated abscess is difficult to drain percutaneously. We report a case of multiloculated retroperitoneal abscess successfully treated by percutaneous drainage with a Malecot catheter. A 47-year-old woman complained of fever and left flank pain. The peripheral while blood cell count was 16,800/mm3 and the blood sugar was 369 mg/dl. The computer tomographic (CT) scan showed a large multiloculated mass in the left retroperitoneum. An aspiration needle was inserted into the perinephric mass under ultrasonographic guidance. The definitive diagnosis of abscess was made by aspiration of purulent fluid. A 20 Fr. Malecot catheter was passed over the guide wire under fluoroscopic guidance. Two hundred ml of pus was smoothly aspirated. Streptococcus agalactiae was isolated from the aspirate. Antibiotics and insulin were started. The catheter was retained for 49 days until ultrasonography revealed disappearance of the abscess. One year later, she had no symptoms of recurrence.     

Malignant pheochromocytoma with liver invasion treated successfully by combined retroperitoneal laparoscopic control of arterial in-flow followed by open hepatectomy: A case report

IntroductionPheochromocytoma surgery is generally challenging for surgeons and anesthesiologists for cardiovascular complications.Presentation of caseA 54-year-old Japanese man was found to have a large right pheochromocytoma infiltrating the posterior part of his liver and vena cava and multiple lung metastases. After retroperitoneal laparoscopic dissection of the dorsal side of the tumor and ligation of the feeding vessels, total resection of the primary tumor, extended posterior sectional hepatectomy, and partial vena cava resection were performed by open surgery via a thoracoabdominal approach. Abundant congestive bleeding with instability of vital signs occurred during transection. It could be finally controlled by dissect the remnant feeding artery in the inmost space. Prior control of arterial in-flow enabled successful completion of the planned surgical procedure. The patient has now survived for 27 months since resection of the primary lesion.ConclusionLigation of the feeding arteries to this hypervascular catecholamine-releasing tumor via a retroperitoneal laparoscopic approach prior to performing combined organ resection facilitated successful excision of this large malignant pheochromocytoma.     

A case of primary retroperitoneal mucinous cystadenocarcinoma

A 41-year-old Japanese woman was admitted to our hospital for right abdominal mass. Various examinations revealed a retroperitoneal lymphangioma. Tumor resection was performed and pathological diagnosis was a mucinous cystadenocarcinoma. It seems that screening with the tumor markers will be helpful for the diagnosis, because it is very difficult to diagnose a retroperitoneal mucinous cystadenocarcinoma before the operation.     

腹腔镜治疗卵巢粘液性囊腺瘤的临床探讨

目的:探讨腹腔镜手术治疗卵巢粘液性囊腺瘤的可行性。方法:回顾分析71例粘液性卵巢瘤患者的临床资料,39例行腹腔镜手术作为观察组,32例行开腹手术作为对照组,比较两组术中肿瘤穿破情况、术中出血、手术时间及术后复发率等。结果:观察组术中见肿瘤直径4.5～13cm,平均(6.28±1.94)cm,对照组肿瘤直径6～25cm,平均(7.75±3.93)cm。术中肿瘤穿破(标本袋外穿破)观察组23例,对照组11例。平均手术时间观察组(59.62±18.50)min(40～110min),对照组(52.81±9.83)min(45～90min),两组差异无统计学意义(P0.05)。术中平均出血观察组(32.69±15.25)ml(10～70ml),对照组(43.12±20.86)ml(30～100ml),两组差异有统计学意义(P0.05)。术后随访16～72个月,平均47个月,复发率观察组10.26%,对照组15.63%,两组差异无统计学意义(P0.05),患者均生存。结论:腹腔镜治疗粘液性囊腺瘤与开腹手术效果相近,不影响术后复发率。     

A case of pyonephrosis with septic shock in a hemodialysis patient treated successfully by retroperitoneal drainage

A 56-year-old man on long-term hemodialysis was admitted to our hospital with complaints of right back pain and low-grade fever. Physical examination and laboratory data revealed severe hypotension and coagulopathy. Abdominal computed tomography showed a low dense area at the back of the right atrophic kidney. Under the clinical diagnosis of pyonephrosis spreading around the kidney with septic shock and disseminated intravascular coagulation, we performed drainage of retroperitoneal abscess. General condition improved postoperatively and right nephrectomy was performed two weeks after the drainage.     

Sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery: A case report

We report a case of sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery. A 38-year old asymptomatic woman was referred to our hospital for evaluation of a submucosal tumor of the stomach. Endoscopic examination showed a solitary submucosal tumor without ulceration or central depression on the posterior wall of the antrum and biopsy specimens were not sufficient to determine the diagnosis. Endoscopic ultrasound revealed a tumor nearly 2 cm in diameter arising from the muscle layer and a computed tomography scan showed the tumor enhanced in the arterial phase. Laparoscopic wedge resection was performed for definitive diagnosis. Pathologically, the tumor was shown to be gastric carcinoid infiltrating the muscle layer which indicated the probability of lymph node metastasis. Serum gastrin levels were normal. As a radical treatment, laparoscopy-assisted distal gastrectomy with regional lymphadenectomy was performed 3 wk after the initial surgery. Finally, pathological examination revealed no lymph node metastasis.