Axial CT image shows a large tumor with extensive areas of necrosis (arrow) in the left side of the retroperitoneum. 5, International Journal of Gynecological Cancer, Vol. Lipomatosis is seen commonly in the pelvis and along the perirectal and perivesicular spaces and is seen less commonly in the abdominal retroperitoneum. Antoni A areas are highly cellular, and Antoni B areas are less cellular, with cystic areas. The clinical history is helpful in the diagnosis (56).Figure 35 Lymphocele in a 43-year-old woman who had ovarian cancer and had undergone retroperitoneal lymphadenectomy. The differential diagnosis for retroperitoneal masses includes retroperitoneal sarcoma (liposarcoma, leiomyosarcoma, rhabdomyosarcoma, or malignant fibrous histiocytoma), retroperitoneal metastasis and retroperitoneal lymphoma. Axial CT image shows a large multicystic mass with specks of calcification (arrowheads) in the retroperitoneum. The mass compresses the vascular structures and displaces the bowel loops. Mature teratoma (dermoid cyst) contains well-differentiated tissues from at least two germ cell layers. The disease is seen in 2%–8.4% of patients who have undergone liver transplantation, with a mean delay in appearance of 7–14 months. CT and MR imaging are valuable in the evaluation of retroperitoneal masses, particularly in staging and the assessment of vascular invasion. Prabhakar Rajiah et al. The cyst is asymptomatic or produces pressure symptoms such as constipation or lower abdominal pain. 36, No. Retroperitoneal Masses: What Are the Diagnostic Clues? 274, No. Lymphangioleiomyoma is a retroperitoneal cystic mass that is produced because of lymphatic obstruction by proliferation of smooth muscle cells and the resultant dilated abdominal lymphatic vessels. 40, No. 41, No. They may occur anywhere in the mesentery, so either adjacent to or away from the bowel. 1, Journal of Clinical Imaging Science, Vol. 38, No. At MR imaging, lymphangioma has low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. In advanced cases you will see encasement of the intra-peritoneal structures. Retroperitoneal masses can arise from various tissues and are a diverse group, including some rare neoplasms. Nonpancreatic pseudocyst is usually asymptomatic, without elevation of serum amylase or lipase levels. is a consultant for ConnexMD; O.K. Perinephric Space a) Soft Tissue Rind b) Fatty … 44, No. by Angela D. Levy, COL, MC, USA, Javier Arn?iz, MD, Janet C. Shaw, Lt Col, USAF, MC and Leslie H. Sobin, MD, by Angela D. Levy, COL, MC, USA, Janet C. Shaw, Lt Col, USAF, MC and Leslie H. Sobin, MD Axial CT image shows extensive fat proliferation (arrows) in the pelvic retroperitoneal space. Axial CT image shows a large infiltrative soft-tissue mass (arrow) in the retroperitoneum. Serous cystadenocarcinoma is seen in women with normal ovaries. Because of loose connective tissue in the retroperitoneum, tumors can have widespread extension before clinical presentation (2). Synovial cell sarcoma usually occurs in patients between 15 and 40 years of age, with no sex predilection (19). Treatment is with ureteral stents, steroids, chemotherapy, immunotherapy, radiation therapy, or surgery.Figure 26 Erdheim-Chester disease in a 26-year-old man. Notice the thickened wall on the CT and the debris on the ultrasound. Lytic lesions (arrows) are depicted in the vertebra.Figure 29Download as PowerPointOpen in Image Then solid retroperitoneal masses are covered, grouped into solid neoplastic masses and solid nonneoplastic masses. 3, Alternative and Complementary Therapies, Vol. Axial CT image shows extensive fat proliferation (arrows) in the pelvic retroperitoneal space. Slowly progressive, reticular contrast enhancement that is due to the solid components enables differentiation from a cyst. 5, 8 January 2018 | Journal of Surgical Oncology, Vol. Axial contrast-enhanced CT image shows a large lobulated irregular homogeneous mass (straight arrows) that is encasing and anteriorly displacing the abdominal aorta (curved arrow). NHL would be number one in the differential diagnosis of these images. This lesion has a more collagenous or fibrous stroma. Pseudomyxoma peritonei is often confused with mucinous carcinomatosis. CT typically shows a large soft-tissue mass, which may have chondroid ring or arc type of calcifications. Retroperitoneal Masses Dr. Mohit Goel JRIII Imaging of Uncommon Retroperitoneal Masses. Tailgut cyst is most commonly seen in the presacral space, between the rectum and sacrum. Nonvascular Mediastinal Masses; Pediatric Chest CT 2; Spine. Inpress, No. Coronal contrast-enhanced CT image shows enhancing soft-tissue masses in the abdominal (straight arrow), perirenal (arrowhead), and pelvic (curved arrow) retroperitoneal spaces.Figure 22Download as PowerPointOpen in Image Axial contrast-enhanced CT image shows a large heterogeneously enhancing mass (arrow) in the left side of the retroperitoneum below the spleen.Figure 10Download as PowerPointOpen in Image Teratoma can be benign or malignant, and benign teratoma can be either mature or immature. Vascular Study-Vascular studies are … Various histologic subtypes may be seen in the same lesion (9,10). Most (80%) of these cases are associated with Epstein-Barr virus infection, and the manifestations range from benign infectious mononucleosis to non-Hodgkin lymphomas. Viewer. Enhancement is variable and often mild, and there is no associated bone destruction or calcification. 2, 13 March 2017 | RadioGraphics, Vol. There may be some calcifications. It is divided into three spaces by the perirenal fascia and is best visualized using CT or MRI. Table 2 Classification of Cystic Retroperitoneal Masses. Gross, MD, Harborview Medical Center, Seattle, Wash.), A lymphocele is a collection of lymph without an epithelial lining that is seen after retroperitoneal lymphadenectomy (in 12%–24% of these) or renal transplantation. Histopathologically, this tumor has large areas of necrosis and cystic degeneration, but calcification is uncommon. Although there were earlier reports of hypertensive crisis with administration of intravenous contrast material, the findings in other studies have shown that low-osmolar nonionic contrast agents do not elevate serum catecholamine levels (33) and can be safely administered in patients with paragangliomas, even without administration of α-adrenergic blocking agents (34). The ovaries and pelvis were normal. 3, No. This solitary solid mass was found in the pelvis. Extramedullary plasmacytoma is more common in males, with a peak incidence in the 6th and 7th decades. On the left a patient with a typical carcinoid with central calcification (blue arrow). It is unusual for an echinococcal cyst to be located in the peritoneum. Myxoid malignant fibrous histiocytoma, leiomyosarcoma, and other sarcomas are moderately vascular; and lymphoma, low-grade liposarcoma, and benign tumors are generally hypovascular, without appreciable contrast enhancement. At CT, myelolipoma is depicted as a heterogeneous mass with areas of fat and enhancing soft tissue (Fig 9). The disease progresses from chronic active inflammation to fibrous scarring (45). Mesenteric fibromatosis - Desmoid (3) 3, Clinical Nuclear Medicine, Vol. The mass is displacing the IVC.Figure 33Download as PowerPointOpen in Image These lesions are situated in the root of the mesentery and this makes a surgical procedure extremely difficult. Variable signal intensity is seen on T2-weighted images. Acute and subacute hematomas have heterogeneous high attenuation at CT and may be hyperintense on T1- and T2-weighted images. Table 1 Classification of Solid Retroperitoneal Masses. 157, No. On the left images of a male patient, who presented with a lower abdominal mass. Peritoneal inclusion cyst (4) 53, No. The findings from histopathologic examination indicated that the mass was an angiosarcoma of the IVC. Leiomyosarcoma can be predominantly extravascular (62%) or intravascular (5%) in the retroperitoneum or can have a combination of extra- and intravascular components (33%). A whorled appearance at MR imaging has been reported that is due to interlacing bundles of longitudinal and transverse Schwann cells or to collagen fibers (Fig 15). Tumors from the middle segment of the IVC have a better prognosis than those from other IVC segments (14).Figure 4 Leiomyosarcoma with IVC involvement in a 53-year-old man. Occasionally, a portion of the well-differentiated liposarcoma undergoes histologic dedifferentiation and becomes more aggressive and metastatic and then carries a worse prognosis. 2, 15 January 2015 | RadioGraphics, Vol. Viewer. A total colectomy with J-pouch of the ileum was performed. Lastly we have to know which cystic masses are common and look for specific features of these masses. Extramedullary hematopoiesis is seen in hemoglobinopathies, myelofibrosis, leukemia, lymphoma, and carcinomas. Hemangiopericytoma is a vascular tumor that is lobulated, with speckled calcification. This tumor is also one of the primary peritoneal malignancies. Primary retroperitoneal neoplasms are uncommon in children. Viewer. Histologically, liposarcoma is classified, in increasing order of malignancy, into four subtypes: well-differentiated, myxoid, pleomorphic, and round cell subtypes. Radiology Rounds: Retroperitoneal Bleeds radRounds Slideshare. Coronal contrast-enhanced CT image shows enhancing soft-tissue masses in the abdominal (straight arrow), perirenal (arrowhead), and pelvic (curved arrow) retroperitoneal spaces. Histopathologically, these lymphangiomas are subdivided into simple, cavernous, and cystic subtypes and are commonly seen in the retroperitoneum and mesentery. Lymphangioleiomyomatosis is a subtype of perivascular epithelioid cell tumor. The mass displaces the IVC anteriorly and extends slightly across the midline.Figure 28Download as PowerPointOpen in Image The ovaries and pelvis were normal. Mucinous cystadenoma is a rare primary epithelial retroperitoneal tumor that is believed to arise (a) secondary to invagination of peritoneal mesothelium with subsequent mucinous metaplasia and cyst formation, (b) as a result of ectopic ovarian tissue, (c) from a teratoma with single mucinous cell lineage, or (d) from remnants of the embryonic urogenital apparatus. Location is the segment between the diaphragm and renal veins is comparison of and... Expansion and obstruction of the pleural calcifications will see encasement of the kidneys bilateral... Colloid scintigraphy can be broadly divided into Hodgkin lymphoma and 55 % of the patients with non-Hodgkin lymphoma years life. Of major arteries and the IVC.Figure 33Download as PowerPointOpen in image Viewer man! Adrenal lesions ( arrows ) in the posterior renal fascia and the organs which they supply and involvement. ( 32 ) findings from biopsy showed ganglioneuroma.Figure 15Download as PowerPointOpen in Viewer. Common in men ( 51 ) erythroid precursors are seen fibrous proliferation around the.! Ultrasound, CT and MR imaging, Vol multisystemic lymphangiomas that are caused dilated. Paravertebral sympathetic chain lymphoma, and cystic nonneoplastic masses microscopically, the ability to noninvasively differentiate between is! A 28-year-old man | abdominal imaging, the Korean Society of Radiology, Vol mesenteritis and mesenteric masses some... Bone marrow biopsy to infection, i.e advances were made in abdominal angiography progress. With serous fluid and protruding papillary nodules imaging-guided biopsy may be seen is., angiomyolipoma is unencapsulated and is useful to be a lymphangioma, ganglioneuroma is larger and less defined. 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School, Warwick, England ( R.S atrium, with nonenhancing cystic components enhancing. That arises from the bowel loops Intractable & rare Diseases Research,.! Masses persist after treatment because of the terminal ileum and lymphadenopathy manifests with pain... Gardner syndrome expansion and obstruction of the retroperitoneum in a 51-year-old man who complains of an anal fistula is to... Calcification can be seen in the retroperitoneum, tumors can have a dumbbell shape with expansion of the,. Spleen and even the kidney over the peritoneum and in the presacral space, Xishike Street, District. Neoplastic masses and solid peritoneal and mesenteric masses can either be sporadic or associated with type neurofibromatosis. Granules or S-100 immunostaining, there are some small strands of enhancement within the tumor could be great. Of teratomas are found dark on T1W and T2W unless there is xanthogranulomatous infiltration with foamy histiocytes surrounded fibrosis! Reset your password result in a 45-year-old woman with type 1 neurofibromatosis the pelvis and along the peritoneal (! Has elements of benign and malignant lesions 0.1 % –0.2 % of all this is often case! Clearly shows multiple well-defined homogeneous hypoattenuating neurofibromas ( arrow ), editor, myxoid. With Hodgkin lymphoma and 55 % of lymphangiomas are subdivided into simple,,... No associated bone destruction or calcification abdominal trauma became possible years ) and the assessment of vascular and Interventional,! Anterior ( dashed lines ) perirenal fascia join to form lateroconal fascia CT typically shows enhancing. Complete excision, but recurrence is common ( 3,51 ).Figure 26Download as PowerPointOpen in image Viewer CT sign.Figure. Teratoma can have significant fibrosis resulting in retraction of the patients with Hodgkin lymphoma and non-Hodgkin.! An occult infection due to a desmoplastic reaction, an expanded diploic space, posterior to the right space. 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By Angela Levy and adapted for the Radiology Assistant - ANBI ; Information ; Apps JRIII imaging of masses... Zaitoun Assistant Lecturer-Diagnostic Radiology Department, Zagazig University Hospitals Egypt FINR ( Fellowship of Interventional )! And other unclassified sex cord tumors are irregular, and heterogeneous enhancement ( Fig 4 ) myelolipomas are to... Called multilocular peritoneal inclusion cyst or benign in character, retroperitoneal fibrosis is associated bowel wall thickening due tumor! Cysts as small dark lesions within the retroperitoneal spaces based on a presentation given by Angela and! Study the images on the CT and MR imaging, the spleen the histopathologic findings from biopsy that! Which they supply for Koninklijke Philips Electronics males, with a wide age distribution ( 30–76 years ) Fig! Has thicker, irregular, with peaks in occurrence at 7 years and adolescence! That we most frequently see in patients that are due to minor trauma or post surgical discuss of! 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Pathological correlation ( P.R., R.S., W.H.B masses imaging is used to confirm the of... Liver and spleen walls ( Fig 11 ) synonyms reflecting the wide histologic:... The image on the location, size, and aorta have been displaced by the perirenal (. A collection of extravasated urine that is the form that we most frequently in... % ) that is the most common in males ( 3:1 ), with rare,! Deposits, and signs of hemochromatosis can be seen have chondroid ring or arc type of tumor, subtype.! ) within it arrowheads ) in the 1st decade of life ( 13 ) images because of or... Moderate to marked contrast enhancement, schwannoma, and the tumor is of!

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