Retroperitoneal bronchogenic cyst:A case report and review of literature

BACKGROUND Bronchogenic cysts are rare developmental anomalies that belong to the category of congenital enterogenous cysts.They arise from lung buds and are present at birth.The embryonic foregut is their origin.Typically,they are located within the chest cavity,particularly in the cavum mediastinale of the thoracic cavity or lodged in the pulmonary parenchyma,and are considered a type of lung bud malformation.CASE SUMMARY A 49-year-old male patient was admitted to the hospital due to the detection of a retroperitoneal mass during a physical examination.Two weeks before admission,the patient underwent a physical examination and routine laboratory tests,which revealed a space-occupying mass in the retroperitoneal region.The patient did not report any symptoms(such as abdominal pain,flatulence,nausea,vomiting,high fever,or chills).The computed tomography(CT)revealed a retroperitoneal spaceoccupying lesion with minimal enhancement and a CT value of approximately 36 Hounsfield units.The lesion was not delineated from the boundary of the pancreatic body and was closely related to the retroperitoneum locally.CONCLUSION Following a series of tests,an abdominal mass was identified,prompting the implementation of a laparoscopic retroperitoneal mass excision procedure.During the investigation,an 8 cm×7 cm cystic round-shaped mass with a distinct demarcation was identified in the upper posterior region of the pancreas.Subsequently,full resection of the mass was performed.Postoperative pathological examination reveled a cystic mass characterized by a smooth inner wall.The cystic mass was found to contain a white,viscous liquid within its capsule.

Large retroperitoneal atypical spindle cell lipomatous tumor,an extremely rare neoplasm:A case report

BACKGROUND Atypical spindle cell lipomatous tumor(ASLT)is a rare soft tissue neoplasm with a low potential for malignancy.ASLT frequently occurs in the limb and limb girdles.However,large retroperitoneal ASLTs are extremely rare.There was no concrete case report of retroperitoneal ASLTs.CASE SUMMARY An 18-year-old woman presented with abdominal pain and a palpable mass.Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity.Surgical excision was indicated.The tumor did not invade the adjacent organs.The pelvic cavity was then too narrow to dissect smoothly.The mass was successfully excised without tumor rupture or adjacent organ injury.Microscopically,the neoplasm was a well-differentiated adipocytic neoplasm.Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin,in addition to multifocal positivity for S100 protein.These histological features were consistent with an ASLT.The patient’s postoperative course was uneventful.At the 12-mo followup,no evidence of recurrence or metastasis was observed.CONCLUSION To the best of our knowledge,our study is the first concrete report of a large retroperitoneal ASLT in the English literature.In the large retroperitoneal ASLT located in the pelvic cavity,which made it too narrow and tight to dissect,complete excision is difficult but very important because of recurrence risk.Although large retroperitoneal ASLTs are considered extremely rare,their detection is important for accurate evaluation and management.Owing to their significant rarity,retrospective multicenter case studies are required to determine the clinicopathologic characteristics.

Laparoscopic resection of primary retroperitoneal schwannoma:A case report

BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs,symptoms and imaging tests.Thus,it is necessary performing guided punch biopsy in order to identify it.Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure,without complications,evolved with severe pain in the lower limbs,thigh and gluteal region associated with neurogenic claudication.Persistent pain required magnetic resonance imaging(MRI)of the lumbar spine,which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion.The surgical team opted for draining the collection,as well as requested an MRI of the abdomen and pelvis,whose analysis showed expansive lesion in the retroperitoneum,in close contact with the inferior vena cava and with the right renal vein.A guided puncture was performed for diagnostic clarification,which showed immunohistochemical profile compatible with schwannoma.The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy.The patient was discharged and remained stable after 4-mo follow-up;she remains under followup to check the need of cancer investigations.CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection,which often presents low relapse rates and optimistic prognosis.

Primary extra-pancreatic pancreatic-type acinar cell carcinoma in the right perinephric space: A case report and review of literature

BACKGROUND Primary extra-pancreatic pancreatic-type acinar cell carcinoma(ACC)is a rare malignancy,and has only been reported in the gastrointestinal tract,liver,and lymph nodes until now.Extra-pancreatic pancreatic-type ACC in the perinephric space has not been reported.Herein,we report the first case of ACC in the perinephric space and describe its clinical and imaging features,which should be considered when differentiating perinephric space neoplasms.CASE SUMMARY A 48-year-old man with a 5-year history of hypertension was incidentally found to have an asymptomatic right retroperitoneal mass during a routine health check-up.Laboratory tests were normal.Abdominal computed tomography and magnetic resonance imaging showed an oval hypervascular mass with a central scar and enhanced capsule in the right perinephric space.After surgical resection of the neoplasm,the diagnosis was primary extra-pancreatic pancreatic-type ACC.The patient was alive without recurrence or metastasis during a 15-mo follow-up.CONCLUSION This is the first report of an extra-pancreatic ACC in right perinephric space,which should be considered as a possible diagnosis in perinephric tumors.

Computed tomographic differentiation between alcoholic and gallstone pancreatitis:Significance of distribution of infiltration or fluid collection

AIM： To evaluate the usefulness of various computed tomography （CT） findings including distribution of infiltration or fluid collection in differentiating the major etiologies of acute pancreatitis. METHODS： We reviewed 75 relatively severe cases of acute pancreatitis of alcoholic （n = 43） or biliary stone （n = 32） etiology having infiltration or fluid collection on CT. We compared the pancreatic size, CT grading, presence or absence of biliary calculi, and dilatation of pancreatic or bile duct. We also evaluated degree and the distribution of infiltration and fluid collection in each group. RESULTS： The sizes of pancreas were not different between alcohol group and stone group. Alcohol group showed higher CT grading than stone group （P 〈 0.05）. Presence of biliary stone and duct dilatation was statistically significant in differentiating etiology （P 〈 0.05）. Alcohol group showed significantly prominent peripancreatic pathology than stone group only in left peritoneal compartment （P = 0.020）. CONCLUSION： Alcoholic pancreatitis tends to form more prominent peripancreatic changes than gallstone pancreatitis in relatively severe cases. This is evident on the anterior aspect of left abdomen. Although clinical history and some CT findings usually are a major determinant of the etiology, this pattern of peripancreatic pathology may have an ancillary role in determining the etiologies of acute pancreatitis in the equivocal cases.

Management of symptomatic ureteric stumps laparoscopically

Aim: To study the advantage of excision of the distal symptomatic ureteric stumps with the retroperitoneal laparo-scopic approach. Methods: Four patients who had failed to settle their symptoms with the initial conservative man-agement were included in the study. All underwent excision of the distal symptomatic ureteric stumps with the retroperi-toneal laparoscopic approach and then received prophylactic antibiotics. Results: We have achieved better resultsthan those reported in the literature in terms of operating time (mean 1 h 45 min), blood loss ( < 10 mL), postopera-tive recovery (within 12 h) and hospital stay ( < 48 h). Conclusion; Retroperitoneal laparoscopic excision is asafe, simple and effective method in the management of symptomatic ureteric stumps.

Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection in pancreatic head cancer

Background Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior, which is characterized by neural infiltration. This study aimed to investigate the clinical significance of radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection for carcinoma of the pancreatic head.Methods Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005. The patients were divided into two groups： radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection （group A, n=25） and routine Whipple＇s operation （group B, n=-21）. There were no significant differences between the two groups in relation to age, gender and preoperative risk factors, and perioperative conditions, patholoclical data and survival rates were studied.Results There were no significant differences in tumor size, surgical procedure time, postoperative complications, and time of hospitalization. However, the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B （P〈0.05）. The 1- and 3-year survival rate in group A were 80% and 53%, respectively, which was higher than those in group B （P〈0.05）. There were significant differences in the survival rates between patients with and without nerve infiltration in group A （P〈0.05）.Conclusions Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection, can effectively remove the lymph and nerve tissues that were infiltrated by tumor. Meanwhile, this method can reduce the local recurrence rate so as to improve the long-term survival of patients.

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.

Pelvic compartment syndrome caused by retroperitoneal hematoma of pelvic fracture

Retroperitoneal hematoma is an obligatory complication in pelvic ring fracture.~1 In most cases, the bleeding originates from venous vessels of the presacral plexus, small arteries and veins from fracture fragments. External fixation of the pelvis can control blood loss by reducing diastasis and dramatically decreasing the volume of the pelvis. But this tamponade effect can not prevent the presence of hematoma in the adjoining retroperitoneal space. It is well known that complication of retroperitoneal hematoma is infection and sepsis.