Humans ; Paraganglioma/complications* ; Retroperitoneal Neoplasms/diagnostic imaging* ; Retroperitoneal Space ; Tachycardia

Acute Kidney Injury ; diagnostic imaging ; etiology ; Aged ; Humans ; Male ; Necrosis ; diagnostic imaging ; etiology ; Paraganglioma ; complications ; Postoperative Complications ; Retroperitoneal Neoplasms ; complications ; Skin ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.

METHODSTo analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.

RESULTSThe lesions (benign=28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7). The tumors showed heterogeneous density on unenhanced CT (n=25). Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast. The enhancement patterns included whole enhancement (n=9), solid area enhancement (n=12), peripheral enhancement (n=1), and spotted enhancement (n=1). The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement. The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3). Besides that the morphology had statistical significance (P=0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.

CONCLUSIONSRetroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes. Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

Adrenal Gland Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; Diagnosis, Differential ; Humans ; Hypertension ; Image Enhancement ; Pheochromocytoma ; diagnostic imaging ; pathology ; Retroperitoneal Space ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDBenign and malignant primary retroperitoneal tumors (RT) have different pathological manifestations, and overlapping imaging characteristics. This study aimed to evaluate the value of computed tomography (CT) for differentiating benign from malignant RT.

METHODSOne hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT. There were 38.1% (n = 74) benign lesions and 61.9% (n = 120) malignant lesions. Categorical variables were tested with a chi-square test or Fisher's exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.

RESULTSIn univariate analysis, the differences in ill-defined margins, irregular surfaces, long diameter >6.75 cm, short diameter >6.25 cm, and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2% and 91.9%, 70.0% and 62.2%, 68.8% and 60.7%, 59.7% and 74.2%, 87.5% and 35.1%, respectively. In multivariate analysis, a combination of all the above indexes was the best model for differentiating malignant tumors, resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2% and a specificity of 81.1% (P < 0.0001) when the score was 4. The differences in other findings including CT attenuation, number, and calcification had no statistical significance. The unique characteristics included the spotted enhancement (mottled high density) in schwannoma (P < 0.0001), adipose tissue in liposarcoma (P < 0.0001) and paravertebral location in neurogenic tumors (P < 0.0001).

CONCLUSIONSMore accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT. Some specific characteristics of CT can assist in preoperative planning.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Retroperitoneal Neoplasms ; diagnosis ; diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; methods ; Young Adult

OBJECTIVETo explore the clinical characteristics, diagnosis and treatment regimens for retroperitoneal schwannoma.

METHODSClinicopathological data of 53 retroperitoneal schwannoma patients treated from January 1999 to April 2013 in our hospital were collected and analyzed using SPSS 13.0 statistical software.

RESULTSSymptoms of the retroperitoneal schwannoma were vague and nonspecific. 12 patients had interrupted abdominal pain, 9 patients had abdominal discomfort, and only 6 patients presented with abdominal mass while 24 patients were detected by health checkup. There were some characteristics but not specific findings in imaging examination such as CT, ultrasonography and MRI, so preoperative diagnosis rate was low with only 9 patients diagnosed as retroperitoneal schwannoma and 21 patients diagnosed as neurogenic tumor. S-100 immunohistochemisty was very important in pathological diagnosis, and the patients with benign retroperitoneal schwannoma got 100% tumor specific 5-year survival after complete excision while the 5-year survival of malignant retroperitoneal schwannoma was only 50.0%.

CONCLUSIONSRetroperitoneal schwannoma is a rare disease. Most of them are benign tumors, and complete surgical excision is the effective treatment.

Abdominal Pain ; Diagnostic Imaging ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma ; diagnosis ; pathology ; therapy ; Physical Examination ; Retroperitoneal Neoplasms ; diagnosis ; pathology ; therapy ; Retroperitoneal Space ; Treatment Outcome

OBJECTIVETo evaluate the value of angiography in clarifying the origin of the feeding arteries of primary retroperitoneal tumors and to explore the application of embolization therapy in the treating of primary retroperitoneal tumor.

METHODS68 patients with primary retroperitoneal tumor were randomized into conventional tumor resection group (n = 35) and the preoperative embolization group (n = 33). Some clinical data were compared between the preoperative embolization group and the routine operation group, including blood loss, blood transfusion, operation time and adverse reactions after embolization. All the diagnoses were pathologically confirmed. The origins of the tumor-feeding arteries were analyzed. The clinical value of embolization in assisting the surgery as well as in making prognosis was assessed.

RESULTSAccording to their location and size, primary retroperitoneal tumors had feeding arteries from different origins. In this series of cases the tumor blood supply originated from the lumbar artery (81.8%), internal iliac artery (45.5%) and adrenal artery (27.3%). In the preoperative embolization group and conventional surgery group, the blood loss was 912 ml vs. 2 500 ml (P < 0.001), the blood transfusion was 1 000 ml vs. 2 600 ml (P < 0.001), the operation time was 4.1 h vs. 5.9 h (P < 0.001), and the length of hospital stay was 12.5 d vs. 19.8 d (P < 0.001).

CONCLUSIONSThe origins of the feeding arteries in primary retroperitoneal tumors are very complex. Preoperative embolization therapy may effectively reduce the intraoperative blood loss, postoperative adverse events, length of hospital stay, and facilitate the patients' recovery.

Adolescent ; Adult ; Angiography ; Blood Loss, Surgical ; Blood Transfusion ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Preoperative Care ; Retroperitoneal Neoplasms ; diagnostic imaging ; surgery ; therapy ; Young Adult

If a testicular cancer patient has a mass in the retroperitoneum, a metastasis is often the first suspicion, probably leading to improper diagnosis and overtreatment. Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma. A 29-year-old man, who had a history of seminoma, presented with a single retroperitoneal mass suspected to be a metastasis. Because the patient refused radiotherapy, 3 cycles of cisplatin, etoposide, and bleomycin were offered. Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass, with no change in tumor size or characteristics. Subsequently, retroperitoneal lymph node dissection was performed. The dissected tissue contained negative lymph nodes but a single mass in the attached fat. Pathology revealed retroperitoneal schwannoma, which was confirmed by immunohistochemistry. Thus, clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.
Adult ; Antibiotics, Antineoplastic ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Agents, Phytogenic ; therapeutic use ; Bleomycin ; therapeutic use ; Cisplatin ; therapeutic use ; Diagnostic Errors ; Etoposide ; therapeutic use ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Neoplasms, Multiple Primary ; Neurilemmoma ; diagnostic imaging ; drug therapy ; pathology ; Radiography ; Retroperitoneal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; secondary ; Retroperitoneal Space ; Seminoma ; secondary ; surgery ; Testicular Neoplasms ; surgery

Catheter Ablation ; methods ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Multimodal Imaging ; Neoplasm Recurrence, Local ; diagnostic imaging ; surgery ; Nerve Sheath Neoplasms ; diagnostic imaging ; surgery ; Positron-Emission Tomography ; Retroperitoneal Neoplasms ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVEThe purpose of this study was to assess the imaging characteristics of abdominal pheochromocytoma in multiphasic spiral CT scanning, and to determine whether these image characteristics can aid in differentiating pheochromocytoma from other types of tumors or not.

METHODSThe image data of dynamic enhanced CT of 79 pathologically confirmed pheochromocytomas in 70 patients were retrospectively reviewed.

RESULTSAmong the 70 patients, there were 41 patients with endocrine symptoms related to pheochromocytoma, 15 had a latent pheochromocytoma and the remaining 14 cases presented with a non-functioning pheochromocytoma. There were totally 79 tumors in 70 patients, with a single lesion in 63 cases, while multiple lesions in the other 7. Sixty cases had a tumor located in the adrenal gland, while 8 in retroperitoneal space, and 2 cases had both intraadrenal and ectopic lesions simultaneously. Sixty patients had a benign pheochromocytoma, the other 10 had a malignant one or relapse after operation. The average size of the tumor was 5.8 cm (range, 2 approximately 15 cm in the longest diameter). Seventy-seven pheochromocytomas had a well defined boundary except two big ones with a unclear margin, which were finally proven to be malignant. Homogeneous enhancement was found in 6 lesions with a diameter

CONCLUSIONApproximately half of the abdominal pheochromocytomas are lack of endocrine symptoms related with their tumors. However, they may display some typical CT characteristics, such as that a small lesion is often homogeneous but hypervascular, a larger tumor may present hemorrhage, necrosis, and cystic change with rich or moderate blood supply. However, when a small tumor has moderate blood supply, it should be differentiated with an adrenal adenoma; when a big one has moderate blood supply, it should be differentiated with other malignant tumors. Furthermore, a part of malignant pheochromocytomas is really difficult to be differentiated from some benign lesions by spiral CT images alone.

Adenoma ; blood supply ; diagnostic imaging ; surgery ; Adolescent ; Adrenal Gland Neoplasms ; blood supply ; diagnostic imaging ; surgery ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pheochromocytoma ; blood supply ; diagnostic imaging ; surgery ; Radiographic Image Enhancement ; Retroperitoneal Neoplasms ; blood supply ; diagnostic imaging ; surgery ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Young Adult

OBJECTIVETo evaluate the ability of multidetector computed tomography (MDCT) in differentiating ovarian tumors from non-ovarian masses.

METHODSForty-two cases with pelvic masses were examined with 16-row MDCT. All source image of each case was put into workstation for multi-planar reconstruction (MPR) and curved planar reconstruction(CPR). Axial image combined with 2D image was used for determining the relationship of the mass to ovarian vascular pedicle and identifying the normal ovary, which was compared with postoperative pathologic result and the finding during operation. All the data was compared using Fisher's exact test.

RESULTSThere were 28 ovarian tumors and 14 non-ovarian tumors in this series. If the ovarian vascular pedicle sign was used for determining whether the tumor was from the ovary or not, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 89.3%, 85.7%, 92.6%, 80.0% and 88.1%, respectively, with a significant difference in differentiating the tumor from the ovary or non-ovarian organs (P <0.05). If the identification of full normal ovary was used to determine non-ovarian origin of the tumor, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 50.0%, 100.0%, 100.0%, 80.0% and 83.3%, respectively, also with a significant difference in differentiating the tumors from the ovary or non-ovarian organs (P <0.05).

CONCLUSIONMDCT can clearly show the relationship of the tumor to the normal ovary and its vascular pedicle, which is very helpful in differentiating the ovarian tumors from a non-ovarian masses.

Adult ; Aged ; Cystadenocarcinoma, Mucinous ; diagnostic imaging ; Cystadenocarcinoma, Serous ; diagnostic imaging ; Cystadenoma, Mucinous ; diagnostic imaging ; Cystadenoma, Serous ; diagnostic imaging ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Leiomyoma ; diagnostic imaging ; Middle Aged ; Ovarian Neoplasms ; diagnostic imaging ; Ovary ; blood supply ; diagnostic imaging ; Retroperitoneal Neoplasms ; diagnostic imaging ; Teratoma ; diagnostic imaging ; Tomography, X-Ray Computed ; methods ; Uterine Neoplasms ; diagnostic imaging ; Young Adult