Objective: To report a rare case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity for the purpose of improving the diagnosis and treatment of the disease. METHODS: We retrospectively analyzed the clinical data about a case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity, reviewed relevant literature at home and abroad, and investigated the presentation, diagnosis and treatment of the disease. RESULTS: A 47-year-old male patient with epididymal liposarcoma underwent radical left orchiectomy with high ligation of the spermmatic cord. Ten years later, recurrence and metastasis were observed in the retroperitoneal space with a mass of 15.6 × 9.4 × 25.5 cm occupying an area from the upper pole of the left kidney to the pelvic cavity and enclosing the left kidney and upper ureter, for which the patient received radical resection of the retroperitoneal tumor. However, multiple retroperitoneal and intraperitoneal metastases occurred again 4 years later, which was treated by another surgical resection. The patient died of lung failure a year later. CONCLUSIONS Epididymal liposarcoma is a rare entity, which can be diagnosed by careful clinical and radiological examinations and confirmed by pathology. For its treatment, radical inguinal orchiectomy should be performed as early as possible, but the roles of adjuvant radiotherapy and chemotherapy remain controversial. Given the high rate of recurrence and metastasis, long-term follow-up is necessitated for the patient postoperatively.
Epididymis ; pathology ; Genital Neoplasms, Male ; pathology ; Humans ; Kidney ; Liposarcoma ; pathology ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Orchiectomy ; Peritoneal Cavity ; Peritoneal Neoplasms ; secondary ; Retroperitoneal Neoplasms ; secondary ; Retroperitoneal Space

Adult ; Giant Cell Tumor of Bone ; complications ; Humans ; Male ; Retroperitoneal Neoplasms ; secondary

To develop a more appropriate therapeutic strategy for treatment of nonpulmonary visceral metastatic testicular seminoma based on the International Germ Cell Consensus Classification, we reviewed the medical records of patients with nonpulmonary visceral metastatic testicular seminoma who were treated over a 20-year period. Only 15 (2.2%) of the 686 cases of testicular seminoma were nonpulmonary visceral metastatic seminoma. The median age of patients was 38 years (range, 22-53 years). Ten (67%) of the patients had an initial diagnosis of supradiaphragmatic or visceral metastatic disease. In addition to nonpulmonary visceral metastasis, all patients had lymph node metastasis as well, the majority of which involved the retroperitoneal lymph nodes. The median and mean progression-free survival durations after chemotherapy for advanced disease were 19 months and 63.7 months, respectively. Six patients (40%) survived, five relapsed after radiation therapy and four died of chemorefractory disease not dependent on the specific regimen. Although the number of cases reviewed in this study was small, we conclude that the choice of chemotherapeutic regimen among the current treatments for nonpulmonary visceral metastatic seminoma of testis primary does not present a different outcome. Therefore, multimodality therapies using new strategies or new agents are well indicated.
Adult ; Antineoplastic Agents, Combined/administration & dosage* ; Bone Neoplasms/secondary ; Bone Neoplasms/radiotherapy ; Bone Neoplasms/drug therapy ; Combined Modality Therapy ; Human ; Lung Neoplasms/secondary ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/drug therapy ; Lymphatic Metastasis ; Male ; Middle Age ; Retroperitoneal Neoplasms/secondary* ; Retroperitoneal Neoplasms/radiotherapy ; Retroperitoneal Neoplasms/drug therapy* ; Retrospective Studies ; Seminoma/secondary* ; Seminoma/radiotherapy ; Seminoma/drug therapy* ; Testicular Neoplasms/pathology*

INTRODUCTIONBladder cancer is a common malignancy but presentation with metastatic disease is rare. This is the fi rst reported case of duodenal obstruction as a presentation of metastatic bladder cancer.

CLINICAL PICTUREA middle-aged woman presented with nausea, vomiting, weight loss and intermittent haematuria. Radiology and histology confirmed metastatic bladder cancer to the retroperitoneum encasing the duodenum and causing obstruction.

TREATMENTInsertion of a duodenal stent relieved the obstruction and palliative chemoradiotherapy was initiated.

OUTCOMEThe patient died 15 months after diagnosis.

CONCLUSIONSClinicians and radiologists should be aware of atypical presentations of common malignancies.

Adult ; Carcinoma, Transitional Cell ; drug therapy ; secondary ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; surgery ; Fatal Outcome ; Female ; Humans ; Palliative Care ; Retroperitoneal Neoplasms ; complications ; diagnosis ; secondary ; Stents ; Urinary Bladder Neoplasms ; drug therapy ; pathology

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

OBJECTIVETo sum up preliminary experience of successful resection of tumor involving important vessel in 77 cases.

METHODSSeventy-seven cases were treated in this series including 47 cases in male and 30 cases in female. The ages ranged from 18 to 75 years with the average of 57. The tumor involving thoraco-abdominal cavity was in one case with malignant neuroblastoma. The tumor from retro-peritoneum invaded into the whole inferior vena cava (IVC), and into two-thirds of the right atrium. Tumor located in thoracic cavity were in 13 cases including IVC leiomyosarcoma in 2 cases, thymic carcinoma in 3 cases, malignant thymoma in 4 cases, malignant seminoma of superior mediastinum in 1 case, malignant lymphoma in 1 case, lung cancer in 2 cases. The tumor located in abdominal cavity were in 24 cases including renal carcinoma with tumor thrombi in 11 cases, inflammatory pseudotumor of retro-peritoneum in 4 cases, malignant fibrous histiocytoma of retro-peritoneum in 1 case, non-Hodgkin's disease of retro-peritoneum in 1 case, lymph metastasis of retro-peritoneum in 2 cases, paraganglion tumor of the right adrenal gland in 1 case, ampullary carcinoma in 1 case, leiomyosarcoma of abdominal IVC in 1 case, leiomyosarcoma of pelvic cavity and IVC in 1 cases, fibrosarcoma of pelvic cavity in 1 case. Tumor located in four extremities in 6 cases including osteogenic sarcoma in 3 cases, vascular endotheliosarcoma of the left iliac fossa in 1 case, neurofibroma of the left upper extremity in 1 case, lymphoma of double groin in 1 case. Tumor located in neck in 33 cases including carotid body tumor in 32 cases and neurofibroma of the left upper extremity in 1 case.

RESULTSComplete resection of tumor was in 72 cases, with a rate of 93.5%, palliative resection of tumor was in 5 cases with a rate of 6.5%. No operative death occurred. Four cases died during peri-operative period. Reconstruction of involving vessel with vascular graft was in 13 cases, and shaping or patch closure of vessel was applied in 22 cases. Temporary shunt of carotid artery for neck tumor was used in 18 cases. No death occurred for benign tumor. The survival rate more than half year was 90.4%, and more than one year was 84.9%.

CONCLUSIONThe radical resection rate for tumor involving important vessel may be improved with the help of vascular technique.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Retroperitoneal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome ; Vascular Neoplasms ; secondary ; surgery ; Vascular Surgical Procedures ; methods ; Vena Cava, Inferior ; pathology ; surgery

OBJECTIVETo study the proper way of using combined postoperative chemo-radiotherapy and prognostic factors of soft tissue sarcoma.

METHODSThe clinical data of 184 patients were retrospectively reviewed. These patients were devided into surgery group (S, 94 patients), surgery plus postoperative radiotherapy group (S + R, 62 patients) and surgery plus chemotherapy group (S + C, 28 patients).

RESULTSThe 5-year survival rates of S, S + R and S + C groups were 39.4%, 48.4% and 28.6%, respectively. Combined multitherapy was the key to improve survival rate and life quality. Clinical stage, pathological type and therapeutic method were also important prognostic factors for the long term survival.

CONCLUSIONSurgery plus postoperative radiotherapy can improve the 5-year survival rate of soft tissue sarcoma.

Adolescent ; Adult ; Age Factors ; Aged ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Dermatofibrosarcoma ; mortality ; secondary ; therapy ; Female ; Follow-Up Studies ; Humans ; Liposarcoma ; mortality ; secondary ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Retroperitoneal Neoplasms ; mortality ; pathology ; therapy ; Retrospective Studies ; Skin Neoplasms ; mortality ; pathology ; therapy ; Soft Tissue Neoplasms ; mortality ; pathology ; therapy ; Survival Rate

OBJECTIVETo study MMP-2, MMP-9, TIMP-2 and TIMP-1 expression, and their association to invasion and metastasis of neuroblastoma (NB).

METHODSThe staining status was compared of MMP-2, MMP-9, TIMP-2 and TIMP-1 in cryostat sections of tumor tissue in 35 NB patients by immunohistochemistry.

RESULTSStrong expression of MMP-2 was detected only in 2 patients with early stage NB (group A without metastasis), but in 9 and 10 respectively with advanced stage NB (group B with local metastasis and group C with distant metastasis) (compared to group A, P < 0.01). Strong MMP-9 staining was found in 4, 8 and 11 patients for group A, B and C patients (group A vs group C, P < 0.05). The expression of TIMP-2 was the strongest in 4 group A patients, but it decreased with progression of the disease. There was no statistical difference in TIMP-1 expression among the three groups of patients.

CONCLUSIONMMP-2, MMP-9 expression may be related to metastasis and progression of neuroblastoma, while TIMP-2 may have an inhibitory effect.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Lymphatic Metastasis ; Male ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neuroblastoma ; enzymology ; metabolism ; secondary ; Retroperitoneal Neoplasms ; enzymology ; metabolism ; pathology ; Testicular Neoplasms ; enzymology ; metabolism ; secondary ; Tissue Inhibitor of Metalloproteinase-1 ; metabolism ; Tissue Inhibitor of Metalloproteinase-2 ; metabolism

OBJECTIVETo analyze the retroperitoneal lymph node metastasis in epithelial cancer of the ovary and offer scientific indications for lymph node radical dissection.

METHODSFifty-eight patients with ovarian cancer treated from January 1990 to December 2000 were retrospectively reviewed. Single-factor and multifactor analysis with Logistic regression model were performed by SPSS 10.0 statistic software.

RESULTSThe metastasis rates of overall lymph nodes, pelvic nodes and para-aortic nodes were 48.3%, 37.9% and 25.9% respectively, among which no significant difference was noted (P > 0.05). Single-factor analysis showed that tumor location, ascitic condition, clinical stage and the size of residual tumor were associated with retroperitoneal lymph node metastasis. Multifactor analysis revealed that clinical stage and size of residual tumor were independent risk factors for metastasis of retroperitoneal lymph nodes.

CONCLUSIONFor early ovarian cancer patients, it is extremely important to perform radical dissection of the retroperitoneal lymph nodes. For advanced or residual lesions, radical dissection of pelvic nodes and para-aortic nodes could be considered in the second exploration.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Cisplatin ; administration & dosage ; Cyclophosphamide ; administration & dosage ; Cystadenocarcinoma, Mucinous ; drug therapy ; secondary ; surgery ; Cystadenocarcinoma, Serous ; drug therapy ; secondary ; surgery ; Doxorubicin ; administration & dosage ; analogs & derivatives ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Ovarian Neoplasms ; drug therapy ; pathology ; surgery ; Retroperitoneal Space ; Retrospective Studies ; Second-Look Surgery

OBJECTIVETo investigate the diagnosis and treatment of malignant fibrous histiocytoma of the retroperitoneum (MFHR).

METHODSThe clinicopathological features, treatment and prognosis of 31 patients with MFHR were retrospectively analyzed.

RESULTSThe mean age of the patients was 52.7 +/- 14.1 years. Male:Female = 22:9. The primary symptoms were abdominal mass and pain. The average diameter of tumor was 15 cm. The histopathologic types of the tumor were inflammatory, storiform-pleomorphic, myxoid and giant cell in 16, 10, 4 and 1 cases. The overall survival rate of 1-, 3- and 5-year was 61.3% +/- 9.8%, 31.6% +/- 11.3% and 21.1% +/- 11.4% with a median survival time of 17.0 +/- 6.3 months. Complete resection of the tumor was the major prognostic factor. Postoperative radiotherapy of 20 - 45 Gy was able to prolong the median survival from 12.1 +/- 11.6 months of surgery alone to 26.4 +/- 22.0 months of surgery plus postoperative radiotherapy though without statistical significance (P = 0.051). Postoperative CHOP chemotherapy was not shown to be beneficial.

CONCLUSIONChemotherapy remains the important method of cure. The survival in patients with MFHR might be improved by complete resection combined with chemotherapy or/and radiotherapy.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Chemotherapy, Adjuvant ; Cyclophosphamide ; administration & dosage ; Doxorubicin ; administration & dosage ; Female ; Follow-Up Studies ; Histiocytoma, Benign Fibrous ; secondary ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pancreatectomy ; Postoperative Period ; Prednisone ; administration & dosage ; Prognosis ; Radiotherapy, Adjuvant ; Retroperitoneal Neoplasms ; pathology ; surgery ; therapy ; Retrospective Studies ; Splenectomy ; Survival Rate ; Vincristine ; administration & dosage