Primary gastrointestinal stromal tumor in the retroperitoneum

Abstract  Gastrointestinal stromal tumor (GIST) is the most frequent non-epithelial neoplasm in the gastrointestinal tract. GIST has received much attention both for its clinical significance and biological nature, while the retroperitoneal condition identical to GIST has been rarely described. Presented herein is a case of GIST arising from the retroperitoneum in a 67-year-old man. The solid tumor measuring 4 cm was uncovered in the retroperitoneum, between the abdominal aorta and inferior vena cava, on computed tomography. The patient underwent surgical excision of the tumor. Histological examination showed proliferating spindle cells in the clearly demarcated tumor; immunoreactivity for Kit and CD34 in tumor cells confirmed the diagnosis of GIST. The histological origin of GIST is suggested to be gastrointestinal pacemaker cells, because they share specific immunoreactivity for CD117/Kit, which is also relevant to pathogenesis of GIST. The present case was a rare primary GIST in the retroperitoneum with typical immunopathological features.     

超声检查诊断特发性腹膜后纤维化的应用价值

目的：探讨特发性腹膜后纤维化（IRPF）的超声图像特点及其诊断价值。材料和方法：回顾性分析11例IRPF患者的声像图表现。结果：11例患者均表现为腹主动脉周围低回声肿块,包绕腹主动脉。其中,4例包绕下腔静脉,3例病变延伸及髂动脉,9例伴肾积水。结论：IRPF具有特征性声像图表现,超声检查在该症的发现及定性诊断方面具有重要的作用。     

Cross-Femoral Venous By-Pass (Palma’s Procedure) to Relieve Venous Hypertension Due to Retroperitoneal Leiomyosarcoma: A Case Report

Retroperitoneal leiomyosarcoma arising in, or involving, the inferior vena cava or the iliac vein are infrequent tumours. They are usually treated by “en-block” surgery. Venous reconstruction is usually not needed, since collateral circulation can adequately offset the main vessel flow. However, in rare cases, collateral circulation may be insufficient. The authors report a case of leiomyosarcoma infiltrating the left iliac vein. One week after radical resection surgery, the patient developed left leg compartmental syndrome due to venous hypertension.

The patient was successfully treated by thrombectomy of the left femoral vein and cross-femoral venous bypass (Palma’s Procedure) by means of an 8 mm diameter polytetrafluoroethylene (PTFE) prosthesis. To improve the flow inside the graft, an arterio-venous fistula (AVF) was performed. The choice of a prosthetic conduit, its diameter, and the AVF are discussed.     

后腹腔镜下肾部分切除术在治疗肾脏肿瘤中的临床疗效

目的 探讨后腹腔镜下保留肾单位的肾部分切除术在治疗肾脏肿瘤的临床应用价值.方法 回顾性分析施行后腹腔镜保留肾单位的肾部分切除术的70例患者的临床资料,其中男42例,女28例,年龄平均(56±11.8)岁,肿瘤直径(3.4士1.3)cm.结果 70例患者均成功在后腹腔镜下实施手术,无1例术中中转为开放手术.手术时间100～180 min,平均(130±27)min.血管阻断时间20～40min,平均每例患者25 min.术中失血50～800mL.术后出血2例:1例发生在术后第4天,行选择性血管栓塞术后好转;另1例出现在术后第7天,经选择性血管栓塞后未见好转遂行患肾切除术.术后病检:肾透明细胞癌53例,肾乳头状癌12例,肾嫌色细胞癌2例,囊性肾癌2例,肾脏囊肿并出血1例.随访3～18个月无局部复发及远处转移.结论 后腹腔镜下保留肾单位的肾部分切除术治疗早期肾脏肿瘤安全、有效,兼有创伤小、康复快等优点,近期疗效满意,远期疗效有待进一步观察.     

Congenital right sided ureteropelvic junction obstruction in right crossed fused ectopia with extrarenal calyces masquerading as massive retroperitoneal urinoma in a case of blunt trauma abdomen: A diagnostic enigma and novel approach of management

An 18 years old young male presented with history of blunt trauma to abdomen with mild hematuria. The contrast enhanced computerized tomography of abdomen revealed crossed fused right renal ectopia with distal large fluid filled sac confusing with urinoma. A midline laparotomy revealed it to be case of right hydronephrotic ectopic fused kidney with extrarenal calyces with large midline pelvis in retroperitoneum. Tailoring of renal pelvis with preservation of posterior pelvic wall plate and ureteral reconstruction was done which was anastomosed to native right ureter. The patient is doing well in one year of follow-up.     

经腹腔与腹膜后腹腔镜肾癌根治术疗效比较

目的比较经腹腔与经腹膜后入路腹腔镜肾癌根治术的临床效果。方法分析2010年4月至2012年2月间在北京大学第一医院接受腹腔镜肾癌根治术的141例患者资料,其中经腹腔入路组61例、经腹膜后腔入路组80例,比较两种手术入路患者在手术时间、出血量、术后住院日等方面的差异。结果所有141例手术均在腹腔镜下完成。对于经腹腔入路组和经腹膜后腔组,平均手术时间分别为192.1及147.2min（P=0.000）;平均术后住院日分别为5.8d及7.2d（P=0.000）;平均肿瘤长径分别为5.6cm及4.3cm（P=0.001）。在术中出血量、并发症及输血情况等方面无显著性差异。结论经腹腹腔镜和经后腹膜腹腔镜肾癌根治术围手术期均有良好效果,经腹腔入路适合治疗体积较大的肿瘤,术后恢复快,而经腹膜后腔入路具有手术时间短的优势。     

腹膜后纤维化致急性肾功能衰竭(附2例报告)

目的　总结腹膜后纤维化的临床特征 ,以提高对其的早期诊、治水平。方法　通过文献复习对 2例腹膜后纤维化致急性肾功能衰竭的诊断、治疗和预后进行回顾性分析。结果　原发性腹膜后纤维化致急性肾功能衰竭 1例 ,采用带蒂大网膜包裹治疗 ,随访 9月 ,肾功能正常。继发性腹膜后纤维化致急性肾功能衰竭 1例 ,行肾盂造口 ,肾功能恢复良好 ,6个月后死于癌症广泛转移。结论　逆行肾盂造影是腹膜后纤维化的重要诊断手段 ,确诊需经手术和病理。对继发性腹膜后纤维化应警惕是否合并消化道肿瘤。早期诊断和治疗是减少腹膜后纤维化致急性肾功能衰竭的关键。带蒂大网膜包裹术是有效的治疗方法。     

Report of a case: Retroperitoneal mucinous cystadenocarcinoma with rapid progression

IntroductionRetroperitoneal mucinous cystic neoplasms are uncommon, and little is known about the etiology of the disease. Malignant forms of these are extremely rare. Here, we report a case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC), which demonstrated unexpectedly aggressive progression despite finding only a limited area of adenocarcinoma.Presentation of caseA 62-year-old woman with a complaint of abdominal discomfort was admitted to the hospital. Abdominal CT and MRI showed multiple large retroperitoneal cysts dislocating the right kidney nearly to the center of the abdomen. Transabdominal resection of the cysts was performed. Those cysts contained 1100 ml of mucinous fluids in total. Cytological examination of those fluids revealed no malignant cells. The cyst wall was lined with mucinous epithelial cells, and contained some ovarian-type stroma. Also, there was a focal area of adenocarcinoma in the cyst wall, and the lesion was diagnosed as primary retroperitoneal mucinous cystadenocarcinoma. Eight months later, the patient developed lumbar bone metastasis. Chemotherapy with S-1, an oral fluoropyrimidine, and docetaxel had been begun immediately; however, the disease had rapidly spread in the retroperitoneum. Eventually, the patient died of the disease 15 months after surgery.DiscussionRetroperitoneal mucinous cystic neoplasms are considered to be metaplasia of embryonal coelomic epithelium. Complete excision without rupture is essential. However, variance of biological aggressiveness might exist in PRMCs.ConclusionRetroperitoneal mucinous cystadenocarcinoma is a rare tumor, and it is urgently necessary to elucidate the etiology of an effective therapy for the disease.     

腹膜后肿瘤手术中Cattell-Braasch入路应用价值研究

目的 探讨Cattell-Braasch入路在腹膜后肿瘤手术中的应用价值及安全性。方法 对2007年7月至2015年3月北京大学肿瘤医院术中使用Cattell-Braasch入路的47例腹膜后肿瘤病例的临床资料进行回顾性分析。结果 所有病人均完整切除肿瘤。总手术时间110～835 min（平均320 min）,Cattell-Braasch入路所需的时间一般为10～15 min。术中出血量50～4500 mL,肿瘤最大径为3.2～39.5 cm。术中无一例因该手法造成腹腔器官或血管的意外损伤。结论 Cattell-Braasch入路可提供满意的腹膜后间隙术野显露,提高腹膜后肿瘤整块切除的安全性。