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The British Journal of Surgery May 2024
Topics: Humans; Sarcoma; Male; Retroperitoneal Neoplasms; Pelvic Neoplasms; Female; Middle Aged; Adult; Aged; Treatment Outcome
PubMed: 38805374
DOI: 10.1093/bjs/znae128 -
The Journal of International Medical... May 2024Retroperitoneal spindle cell neoplasms are diagnostically challenging. Malignant peripheral nerve sheath tumours (MPNSTs) can sometimes present as sporadic primary...
Retroperitoneal spindle cell neoplasms are diagnostically challenging. Malignant peripheral nerve sheath tumours (MPNSTs) can sometimes present as sporadic primary retroperitoneal tumours. MPNSTs are usually high-grade and highly aggressive tumours and are associated with a poor prognosis. Low-grade MPNSTs are very rarely described. This current case report describes a case of sporadic primary low-grade MPNST presenting as retroperitoneal spindle cell neoplasm. The diagnosis, imaging and immunohistopathological findings, as well as its successful surgical management, are presented.
Topics: Humans; Retroperitoneal Neoplasms; Nerve Sheath Neoplasms; Male; Middle Aged; Diagnosis, Differential; Neoplasm Grading; Sarcoma; Tomography, X-Ray Computed; Female
PubMed: 38759217
DOI: 10.1177/03000605241255504 -
The Journal of Medical Investigation :... 2024We report a case of retroperitoneal laparoscopic radical nephrectomy (LRN) in which the addition of a hand port was necessary and effective. A 52-year-old man with...
We report a case of retroperitoneal laparoscopic radical nephrectomy (LRN) in which the addition of a hand port was necessary and effective. A 52-year-old man with obesity (BMI 40.6 kg/m2) was diagnosed with a 52-mm left renal cell carcinoma (cT1bN0M0). To avoid thick subcutaneous and visceral fat in the abdomen, we selected LRN using a retroperitoneal approach with four ports in the kidney position. During surgery, a large amount of flank pad and perirenal fat prevented us from securing a sufficient surgical field through traction of the kidney with a retractor. A pure laparoscopic procedure was not feasible;therefore, we added a hand port. Subsequently, we removed the flank pad from the hand port and secured the surgical field by tracing the kidney manually. Finally, hand-assisted LRN was completed without an open conversion. In retroperitoneal LRN, we rarely encounter patients for whom a pure laparoscopic procedure is not feasible because of the large amount of flank pad or perirenal fat. It is important to preoperatively confirm not only the BMI but also the amount of flank pad and perirenal fat on imaging. Hand-assisted LRN via the retroperitoneal approach can be safely performed even in extremely obese patients. J. Med. Invest. 71 : 187-190, February, 2024.
Topics: Humans; Male; Nephrectomy; Middle Aged; Kidney Neoplasms; Retroperitoneal Space; Carcinoma, Renal Cell; Hand-Assisted Laparoscopy; Obesity, Morbid; Laparoscopy
PubMed: 38735720
DOI: 10.2152/jmi.71.187 -
International Journal of Critical... 2024Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came...
Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.
PubMed: 38715755
DOI: 10.4103/ijciis.ijciis_45_23 -
Journal of Obstetrics and Gynaecology :... Dec 2024To evaluate outcomes of laparoscopic retroperitoneal para-aortic lymphadenectomy for stage 1b3-3b cervical cancer.
BACKGROUND
To evaluate outcomes of laparoscopic retroperitoneal para-aortic lymphadenectomy for stage 1b3-3b cervical cancer.
METHODS
Pathology databases searched for all para-aortic lymphadenectomy cases 2005-2016. Descriptive statistics were used to analyse baseline characteristics, cox models for treatment affect after accounting for variables, and Kaplan Meier curves for survival (STATA v15).
RESULTS
191 patients had 1b3-3b cervical cancer of which 110 patients had Para-aortic lymphadenectomy. 8 (7.3%) patients stage 1b3, 82 (74.6%) stage 2b, and 20 (18.1%) stage 3b cervical cancer. Mean lymph node count 11.7 (SD7.6). The intra-operative and post-operative 30 day complication rates were 8.8% (CI: 4.3%, 15.7%) and 5.3% (CI: 1.9%, 11.2%) respectively.Para-aortic nodes were apparently positive on CT/MRI in 5/110 (5%) cases. Cancer was found in 10 (8.9%, CI: 4.3%, 15.7%) cases on histology, all received extended field radiotherapy. Only 2 were identified on pre-operative CT/MRI imaging. 3 of 10 suspected node-positive cases on CT/MRI had negative histology. Para-aortic lymphadenectomy led to alteration in staging and radiotherapy management in 8 (8%, CI: 3.7%, 14.6%) patients. Mean overall survival 42.81 months (SD = 31.79 months). Survival was significantly higher for women undergoing PAN (50.57 (SD 30.7) months) compared to those who didn't (31.27 (SD 32.5) months).
CONCLUSION
Laparoscopic retroperitoneal para-aortic lymphadenectomy is an acceptable procedure which can guide treatment in women with locally advanced cervical cancer.
Topics: Humans; Female; Uterine Cervical Neoplasms; Lymph Node Excision; Middle Aged; Retroperitoneal Space; Laparoscopy; Adult; Neoplasm Staging; Treatment Outcome; Retrospective Studies; Lymph Nodes; Lymphatic Metastasis; Postoperative Complications; Aged
PubMed: 38708782
DOI: 10.1080/01443615.2024.2344529 -
Annals of Medicine and Surgery (2012) May 2024To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) with selective artery clamp (SAC) in patients with renal cell carcinoma...
INTRODUCTION
To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) with selective artery clamp (SAC) in patients with renal cell carcinoma (RCC).
METHODS
The authors recruited three men and two women who underwent RLPN for T1 RCC between December 2022 and May 2023 at a tertiary hospital. The median age of the patients was 32 years (range, 25-70 years). The tumour size ranged from 3 to 4.5 cm. The R.E.N.A.L scores were 4x, 5p, 8a, 5a, and 8ah. The median preoperative eGFR was 96.9 (74.3-105.2). Renal computed tomography angiography was performed before the surgery to evaluate the artery branches. The operation time, number of clamped arteries, warm ischaemic time (WIT), intraoperative blood loss, RCC type, postoperative hospital stay, changes in renal function, and complications were evaluated. The follow-up duration was 6 months.
RESULTS
The median operation time was 120 (75-150) minutes. One artery was clamped in four patients, while three were clamped in one patient. The median WIT was 22 (15-30) min, and the median blood loss was 150 (100-300) ml. No complications were recorded, and the resection margin was negative in all patients. The median decrease in eGFR was 6 (4-30%).
CONCLUSIONS
RLPN with SAC for T1 RCC is safe and feasible in clinical practice.
PubMed: 38694288
DOI: 10.1097/MS9.0000000000001921 -
Journal of Biotechnology Jun 2024Testicular cancer is the most common solid malignancy among men aged 15-35. Radical orchiectomy and platinum-based chemotherapy (BEP) are curative in the majority of...
BACKGROUND
Testicular cancer is the most common solid malignancy among men aged 15-35. Radical orchiectomy and platinum-based chemotherapy (BEP) are curative in the majority of patients, including advanced, metastatic cases. According to current urooncology guidelines all non-seminoma patients harbouring post-chemotherapy residual masses of ≥ 1 cm should undergo salvage retroperitoneal lymph node dissection (RPLND). However, only 10% of residual tumors contain viable disease.
OBJECTIVE
To assess patient outcomes and complications considering different treatment regimens and clinical characteristics.
MATERIALS AND METHODS
In a retrospective cross-sectional study patients (n=127) who underwent postchemotherapy RPLND between 2007 and 2023 at our referral center were evaluated. The patients received systemic treatment at various oncology centers. The number of BEP cycles received were occasionally different from standard. Only patients with normal postchemotherapy serum tumor markers and primary testicular or extragonadal germ cell neoplasms were included. Treatment groups were established according to the number of BEP cycles received, and the extent of RPLND (bilateral or modified template). Treatment outcomes and complications were assessed.
RESULTS
Standard 3-4 courses of BEP were received by 100 (78,7%) patients, while 11 (8,7%) patients underwent less, and 16 (12,6%) more courses than standard. On histopathologic evaluation viable germ cell tumor, teratoma, and necrosis/fibrosis was present in 26 (20,5%), 67 (52,7%) and 34 (26,8%) of specimen, respectively. In the 5-6 BEP series subgroup high rate of viable disease (37,5%) was found and significantly more nephrectomies were performed, than other chemotherapy subgroups. Extratesticular GCT, viable disease in residual mass or progression after RPLND indicated lower survival. Mild (Clavien-Dindo I-II) or no postoperative complications were reported in 93,7% of cases.
CONCLUSIONS
The study suggests no significant benefit from exceeding 3-4 courses of BEP. Timely salvage RPLND should be performed in high volume centers for optimal treatment outcomes with acceptable complication rates. Adherence to the Heidenreich criteria is advisable where practical.
Topics: Humans; Male; Testicular Neoplasms; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Adult; Cross-Sectional Studies; Young Adult; Treatment Outcome; Lymph Node Excision; Middle Aged; Adolescent; Neoplasm, Residual; Orchiectomy; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy
PubMed: 38692356
DOI: 10.1016/j.jbiotec.2024.04.018 -
World Journal of Surgical Oncology Apr 2024The objective of this paper is to offer a thorough examination of the clinical presentations, etiology, and treatment strategies associated with perivascular epithelioid...
PURPOSE
The objective of this paper is to offer a thorough examination of the clinical presentations, etiology, and treatment strategies associated with perivascular epithelioid cell tumors (PEComas).
METHODS
This retrospective study examined the comprehensive archival data of PEComa cases diagnosed at Beijing Hospital from 2015 to 2023. The pathology slides of all patients were thoroughly reassessed by two experienced pathologists. A thorough retrospective analysis was undertaken, incorporating clinicopathological data including gender, age at diagnosis, initial clinical manifestations, signs, disease onset site, tumor markers, imaging findings, therapeutic modalities, pathological features, immunohistochemical profiles, treatment responses, and prognostic indicators. Patients were evaluated for disease severity according to established pathological classification criteria and were followed up until the designated analysis cut-off date. In instances where patients were unable to be monitored on-site, they were contacted via telephone for postoperative follow-up inquiries.
RESULTS
This study included 11 patients with ages ranging from 17 to 66 years old, presenting with the disease in multiple anatomical sites, including the retroperitoneum (2/11), liver (4/11), kidney (4/11), lung (1/11), and broad ligament of the uterus (1/11). Most patients presented with non-specific clinical symptoms and were subsequently diagnosed with space-occupying lesions upon physical examination. The tumor demonstrated progressive growth and enlargement, which could result in compression of neighboring organs. Preoperative imaging alone is insufficient for a definitive diagnosis of PEComa, but MRI can provide an initial evaluation of the tumor's potential malignancy. Molecular marker testing specific to PEComa, such as HMB-45 (90.0%), SMA (81.8%), Melan-A (90.9%), vimentin (90.9%), and Desmin (36.3%), was conducted on all patients. No adjuvant therapies were administered postoperatively. Upon analysis, no instances of relapse at the primary site or the development of new tumors at other sites were observed. Regular imaging reviews of three patients with malignant PEComa post-surgery showed no evidence of recurrence.
CONCLUSIONS
The clinical presentation, tumor biomarkers, and imaging characteristics of PEComa lack specificity, necessitating dependence on pathology and immunohistochemistry for precise diagnosis. The mainstay of treatment consists of surgical resection, with patients typically experiencing a favorable prognosis.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Young Adult; Biomarkers, Tumor; Follow-Up Studies; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Perivascular Epithelioid Cell Neoplasms; Prognosis; Retroperitoneal Neoplasms; Retrospective Studies
PubMed: 38689335
DOI: 10.1186/s12957-024-03349-x -
BMC Urology Apr 2024To introduce the surgical technique and our team's extensive experience with tunnel method in laparoscopic adrenalectomy.
BACKGROUND
To introduce the surgical technique and our team's extensive experience with tunnel method in laparoscopic adrenalectomy.
METHODS
From July 2019 to June 2022, we independently designed and conducted 83 cases of " Tunnel Method Laparoscopic Adrenalectomy," a prospective study. There were 45 male and 38 female patients, ages ranged from 25 to 73 years(mean: 44.6 years).The cases included 59 adrenal cortical adenomas, 9 pheochromocytomas, 6 cysts, 4 myelolipomas, 1 ganglioneuroma, and 4 cases of adrenal cortical hyperplasia. In terms of anatomical location, there were 39 cases on the left side, 42 on the right side, and 2 bilateral cases. Tumor diameters ranged from 0.6 to 5.9 cm(mean: 2.9 cm). Utilizing ultrasound monitoring, percutaneous puncture was made either directly to the target organ or its vicinity, and the puncture path was manually marked. Then, under the direct view of a single-port single-channel laparoscope, the path to the target organ in the retroperitoneum or its vicinity was further delineated and separated. This approach allowed for the insertion of the laparoscope and surgical instruments through the affected adrenal gland, thereby separating the surface of the target organ to create sufficient operational space for the adrenalectomy.
RESULTS
All 83 surgeries were successfully completed. A breakdown of the surgical approach reveals that 51 surgeries were done using one puncture hole, 25 with two puncture holes, and 7 with three puncture holes. The operation time ranged from 31 to 105 min (mean: 47 min), with a blood loss of 10 to 220mL (mean: 40 mL). Notably, there were no conversions to open surgery and no intraoperative complications. Postoperative follow-up ranged from 6 to 28 months, during which after re-examination using ultrasound, CT, and other imaging methods, there were no recurrences or other complications detected.
CONCLUSIONS
The completion of the tunnel method laparoscopic adrenalectomy represents a breakthrough, transitioning from the traditional step-by-step separation of retroperitoneal tissues to reach the target organ in conventional retroperitoneoscopic surgery. This method directly accesses the target organ, substantially reducing the damage and complications associated with tissue separation in retroperitoneoscopic surgery, As a result, it provides a new option for minimally invasive surgery of retroperitoneal organs and introduces innovative concepts to retroperitoneoscopic surgery.
Topics: Humans; Adrenalectomy; Female; Male; Middle Aged; Prospective Studies; Laparoscopy; Adult; Aged; Retroperitoneal Space; Adrenal Gland Neoplasms
PubMed: 38689249
DOI: 10.1186/s12894-024-01484-x -
In Vivo (Athens, Greece) 2024Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is frequently associated with the Epstein-Barr virus (EBV) and manifests as non-mass-forming microscopic...
BACKGROUND/AIM
Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is frequently associated with the Epstein-Barr virus (EBV) and manifests as non-mass-forming microscopic lesions within fibrin-rich lesions. Herein, we describe the cytological features of FA-DLBCL.
CASE REPORT
A 72-year-old man presented with a large retroperitoneal cystic mass that was treated by cyst aspiration and laparoscopic excision. Individually dispersed large, atypical cells in a necrotic background contained scant cytoplasm and hyperchromatic nuclei with irregular nuclear contours, frequent karyorrhectic debris, and mitotic figures. A fibrinous exudate with necrotic material attached to the inner surface of the cystic mass contained large, atypical cells that were individually scattered or arranged in small clusters. These were positive for cluster of differentiation 20 and Epstein-Barr virus-encoded RNA in situ hybridization.
CONCLUSION
We cytologically characterized FA-DLBCL as large, atypical cells that were individually scattered or arranged in small clusters in a necrotic background. To the best of our knowledge, we revealed the cytological features of FA-DLBCL.
Topics: Humans; Male; Aged; Lymphoma, Large B-Cell, Diffuse; Fibrin; Cysts; Herpesvirus 4, Human; Epstein-Barr Virus Infections; Retroperitoneal Neoplasms; Tomography, X-Ray Computed
PubMed: 38688594
DOI: 10.21873/invivo.13594