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Primary retroperitoneal mucinous cystadenoma of borderline malignancy is a rare disease, especially in male patients. Often these tumors are not incidentally found due to abdominal symptoms. We present the radiologic abdominal computed tomography scan, surgical, and pathologic images of this unique, rare condition in a male patient. Surgical treatment is recommended to establish diagnosis and treatment., (Copyright © 2013 Elsevier Inc. All rights reserved.)

We describe a 12-year-old girl with a retroperitoneal lymphatic malformation (LM) and horseshoe kidney. The imaging characteristics of the lesions are reported. Retroperitoneal LM coexisting with horseshoe kidney is extremely rare. We hypothesized that they might share the similar etiologic factors. Imaging examinations are helpful in the definition of the 2 lesions and the relationship between them, but no characteristic findings are available to diagnose retroperitoneal LM before surgery. Surgical excision is ideal to treat LM, and the prognosis is good. Although asymptomatic horseshoe kidney need not be treated, it is important for patients to receive regular follow-up because of the propensity for various complications., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To examine histologic findings and clinical outcomes of patients who underwent neck dissection for residual neck masses., Methods: From 1987 to 2008, 968 postchemotherapy retroperitoneal lymph node dissections (RPLND) were performed at our institution. We identified 41 of these patients who underwent a postchemotherapy residual neck mass resection., Results: Thirty-nine patients presented with primary testis, one with retroperitoneal, and one with mediastinal GCT. Teratoma was present in 54% of patients at diagnosis. During the neck dissection, 23 (56.1%) patients had teratoma, 14 (34.2%) had fibrosis, three (7.3%) had viable GCT, and one had benign lymph nodes. There was histologic discordance between the neck and the RPLND in 22.5% of patients and between the neck and other extraretroperitoneal resection sites in 26.5% of patients. At a median follow-up of 49.5 months from diagnosis, 16 patients had recurrence, and seven had died of testis cancer. No patient had recurrence in the neck. Five of seven patients with residual viable cancer at extraretroperitoneal resection sites died of disease compared with two of 23 with teratoma and none with fibrosis (P = .0005)., Conclusions: Resection of residual postchemotherapy neck masses is indicated because of the high incidence of viable tumor or teratoma in the residual mass and the inability to accurately predict the histology of the neck masses. Resection of residual neck masses leads to excellent local control and can contribute to long-term disease control and survival., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Recently, our institution reported on a rare primary retroperitoneal mucinous cystadenocarcinoma which was only the second type of this kind of tumor ever reported in a male patient. To our knowledge, we report the first male case of a primary mucinous cystadenoma presenting as an enlarging scrotal mass. These lesions are extremely rare and represent only 0.3% of all appendiceal specimens. Because the number of these tumors remains limited, proven treatment regimens and the necessary follow-up have yet to be elucidated. We hope to provide further insight in the monitoring and treatment of these tumors.

Liposarcoma is known to be the most common soft-tissue sarcoma, and the treatment of retroperitoneal disease is surgical excision. We present a case of complete surgical removal with concomitant nephrectomy using a hand-assisted laparoscopic approach and provide a review of the published studies.

Objectives: To present our experience with four retroperitoneal schwannomas treated by surgical excision and review the current literature. Retroperitoneal schwannomas are rare, benign tumors and infrequently present to the urologist., Methods: From 1997 through 2002, the charts of 164 patients with a diagnosis of benign retroperitoneal soft tissue mass were reviewed. Of those, four had a pathologic diagnosis of retroperitoneal schwannoma., Results: Three of the 4 patients were women, with a median age of 54 years (range 46 to 80). The average tumor size was 13.7 cm (range 8.8 to 20). All patients underwent magnetic resonance imaging, computed tomography, or ultrasonography, and 3 of the 4 patients underwent a computed tomography-guided fine needle aspiration biopsy (all were either inaccurate or inconclusive). All patients underwent complete tumor excision with free margins of resection and tolerated surgery without any complications. None of the patients have had any evidence of recurrence at a mean follow-up of 26 months (range 10 to 48)., Conclusions: Retroperitoneal schwannomas are difficult to diagnose preoperatively. Computed tomography-guided fine needle aspiration biopsy does not appear to provide an accurate preoperative diagnosis. The surgical approach should focus on complete excision of the mass. Patients undergoing complete surgical resection tend to do well without evidence of early recurrence.

A primary extragonadal germ cell tumor of the retroperitoneum was diagnosed in a 47-year-old man without elevated serum alpha-fetoprotein, human chorionic gonadotropin, or lactate dehydrogenase levels. The diagnosis was made by histologic analysis after resection. The patient responded well to a combination of cisplatin, etoposide, and ifosfamide, achieving a partial response with four cycles. Residual tumor resection revealed necrotic tissue only. The patient was alive and disease free 24 months after diagnosis. The diagnostic difficulties of this particular situation are discussed.

We report a patient with a history of orchiectomy for Leydig cell tumor of the testis who developed Cushing syndrome. This syndrome was due to ectopic production of cortisol and was the primary feature of tumor recurrence.

Introduction: Retroperitoneal lymph node dissection (RPLND) is the most accurate method for evaluating the presence of retroperitoneal metastases from clinical Stage I nonseminomatous testicular tumors. We have introduced laparoscopy to reduce the morbidity of open RPLND, which is too high for a diagnostic procedure. As the next step, we replaced open surgery with the laparoscopic approach for Stage IIb tumors to remove residual tumor after chemotherapy., Technical Considerations: One prerequisite for laparoscopic RPLND is free access to the retroperitoneum, which can be achieved by wide dissection of the colon and duodenum. The borders of the dissection are the same as with open surgery, and complete dissection can be achieved. Bipolar coagulation and the harmonic scalpel have proved very helpful in achieving adequate hemostasis, a crucial point. Venous lesions can be sealed with fibrin glue., Conclusions: Laparoscopic RPLND is superior to open surgery with regard to morbidity and complication rates, and operative times are equal once enough experience has been collected. The diagnostic accuracy is the same for both methods, and tumor control is not compromised by the laparoscopic approach. The only drawback of laparoscopy is the long and steep learning curve.

Objectives: To further improve the accuracy of the prediction of histologic findings in the residual mass after chemotherapy in patients with metastatic germ cell tumors, various predictive factors were investigated., Methods: A total of 23 patients with advanced testicular cancer underwent combination chemotherapy based on cisplatin following surgical removal of residual tumor mass in 20 patients and observation in 3., Results: Complete fibrosis and/or necrosis was found in 6 (30%) operative specimens, teratoma in 3 (15%), and viable malignant tumor in 11 (55%). Three patients had no evidence of disease for a mean follow-up of 45 months. Five of the 6 patients and all of the 11 patients' results could be predicted by a combination of 4 factors, including absence of teratomatous element in the primary tumor, greater than 85% tumor reduction rate after chemotherapy, normal alpha-fetoprotein and beta-subunit of human chorionic gonadotropin levels after chemotherapy, and actual half-life of alpha-fetoprotein less than 7 days. Among these factors the tumor reduction rate and the actual half-life of alpha-fetoprotein were the most important predictions statistically on multivariate analysis. With the use of these criteria, the sensitivity rate, specificity rate, and overall predictive value of diagnosis for existence of viable malignant tumors were 83.3%, 100%, and 94.1%, respectively., Conclusions: By determining these factors it seems possible to avoid surgical removal of the postchemotherapy residual mass in approximately 30% of patients with advanced metastatic testicular cancer.

Objectives: An appropriate laparoscopic technique for diagnostic retroperitoneal lymph node dissection in clinical Stage I testicular tumors is presented and its efficiency and morbidity are evaluated., Methods: A two-step procedure has been developed. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised and the borders of dissection are defined. Via the ventral approach removal of retroaortic and retrocaval nodal tissue is technically not feasible. Therefore, in the second step, a lateral approach is used, which is the key to success because it permits straightforward transection of the lumbar vessels. Thus, complete lymph node dissection within the boundaries described by Weissbach can be achieved. Between August 1992 and March 1994, this procedure was performed in 15 patients. In 9 patients, the tumor was on the right side and in 6 it was on the left., Results: Conversion to open surgery was necessary in 2 patients because of uncontrollable bleeding and a large metastasis. Microscopic metastasis were detected in 2 other patients. Apart from the bleeding just mentioned, no major complications occurred; no blood transfusions were required., Conclusions: The results obtained so far demonstrate that the technique is feasible and decreases postoperative morbidity. It therefore warrants further consideration.

Presented is a case report of retroperitoneal tumor eleven years after orchiectomy for testicular cancer. Complete remission was achieved with combined chemotherapy and retroperitoneal lymph node dissection. Histologic examination revealed that primary testicular tumor was pure choriocarcinoma and that the retroperitoneal tumor was likely embryonal cell carcinoma without foci of choriocarcinoma. It is difficult to determine whether the retroperitoneal tumor is a late recurrence of testicular cancer of a primary extragonadal germ cell tumor.

Castleman disease (angiofollicular lymph node hyperplasia) has been reported rarely as a solitary retroperitoneal mass radiographically indistinguishable from retroperitoneal malignancies. We report a case of a hyaline-vascular variant of Castleman disease presenting as a pararenal mass. The computerized tomographic and angiographic appearances of this lesion are presented, and the clinical importance of the differential diagnosis of retroperitoneal tumors is discussed.

We believe we report the first case of malignant juxtadrenal schwannoma. This rare tumor was discovered incidentally in a patient who presented with fever, mental confusion, weight loss, leukocytosis, and elevated erythrocyte sedimentation rate. Preoperative radiographic and endocrine evaluations were suggestive of a nonfunctioning adrenal tumor. Its suprarenal location was unequivocally demonstrated by CT scan, sonography, angiography, and magnetic resonance imaging studies. Angiography revealed that the tumor derived its blood supply from the adrenal and renal vessels. The final diagnosis and its juxtadrenal origin was confirmed by histologic and immunohistochemical studies. A review of the literature on retroperitoneal schwannoma is included.

Bipedal lymphangiography (LAG) and abdominal/pelvic computerized tomography (CT) are both useful in evaluating retroperitoneal lymph nodes in early-stage testicular seminoma. Fifty-four patients who had both radiologic studies performed between 1982 and 1986 were identified, and their films were reviewed. Four patients had evidence of retroperitoneal lymph node metastases on both CT and LAG. Of the 50 patients who had normal findings on CT scan, 39 (78%) had a normal LAG and 11 (22%) had a positive LAG. All 11 patients had architectural abnormalities within normal-sized nodes. No patient had positive findings on CT with negative LAG. In addition to aiding in staging, LAG is very useful in designing radiation treatment portals. Therefore, we believe that LAG can continue to play an important role in the accurate staging and treatment of patients with testicular seminoma.

Renal cell carcinoma (hypernephroma) rarely develops as a primary tumor outside the normal confines of the kidney. Although many reports of so-called extrarenal hypernephroma may be found in the literature, very few cases appear to fulfill modern criteria for tumors of true renal origin. Strict criteria for the diagnosis of true extrarenal hypernephroma are proposed, and a case that partially conforms to these standards is presented.

We report on a case of primary monodermal retroperitoneal teratoma composed solely of thyroid tissue. The CT scan appearance of such a tumor is presented.

Retroperitoneal teratoma is the third most common primary retroperitoneal neoplasm of childhood ranking behind neuroblastoma and nephroblastoma. Ten per cent of these tumors are malignant. Two cases of benign retroperitoneal teratoma are reported, and the first description of the angiographic appearance of such a tumor is presented.

A case of benign retroperitoneal Schwannoma is presented, with special attention to clarification of often confused pathologic nomenclature. The radiologic diagnosis and the literature on this rare tumor are reviewed.

A case is reported of a functioning, malignant nonchromaffin paraganglioma (chemodectoma) of the retroperitoneum with metastases in a seventeen-year-old boy. The literature is reviewed and the treatment modalities are discussed.

A case of widespread adenocarcinoma of the prostate presenting as a symptomatic pericardial effusion is reported. The administration of high doses of estrogen produced a marked objective response in this patient

We present the case histories of 3 patients in whom a growing mature teratoma developed twenty-eight, thirty-one, and thirty-three months after successful remission-induction chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB) for a disseminated nonseminomatous testicular tumor (NSTT). The serum tumor markers were not increased. The teratomas were all localized retroperitoneally, two being found near the site of excision of a residual tumor after remission-induction chemotherapy. Two of the 3 patients were alive without further treatment after excision of the teratoma; the third patient did not die of tumor progression, but mature teratoma was still present. Even if the serum tumor markers are not increased, recurrent tumors in patients previously given PVB chemotherapy because of a disseminated NSTT should be excised to establish their histology. En-bloc excision of the recurrent tumor is sufficient. It is pointed out that a mature teratoma can become a large cystic tumor in the course of time: the so-called growing mature teratoma syndrome. We believe that, after remission-induction chemotherapy of disseminated NSTT with a teratoma component in the primary testicular tumor, any residual tumor should be excised to prevent subsequent tumor progression.

Retroperitoneal fibrosis may occur secondary to metastatic neoplasm and may simulate the features of the idiopathic variety. A case of retroperitoneal fibrosis due to gastric carcinoma is presented and the historical, physical, cystoscopic, urographic, operative, and pathologic similarities to the idiopathic form discussed. Generous biopsy of retroperitoneal plaques and careful pathologic examination are stressed to avoid missing malignant disease.

We believe this to be the first case reported of extraosseous myelomatosis seen clincally with lower urinary tract symptoms. Extraskeletal spread of myelomatosis which reportedly occurs in two thirds of cases is discovered postmortem. Immunoglobulin A prevails in this type of myelomatosis. Clinical course and autopsy findings are discussed.

A case report of extragenital tumor of müllerian type arising from the posterior peritoneum and compressing the kidney is presented. The embryologic basis for this type of tumor arising in the peritoneum is discussed.

We report on a twenty-four-year-old woman with extraosseous Ewing sarcoma in the right retroperitoneum. The tumor blocked the common iliac vein, and because of an intervening pregnancy, the blood flow was shunted through the uterus and left ovarian vein back into the vena cava. She died within nine months despite radical surgery, radiotherapy, and chemotherapy.

Two cases are reported of patients with widespread intra-abdominal malignant lymphoma who althoug they initially presented with urologic complaints had no evidence of direct genitourinary involvement. Transrectal biopsy established the diagnosis in both cases. This unusual presentation of lymphoma is discussed together with a review of urologic involvement. The necessity for accurate diagnosis is stressed since effective treatment with radiation and chemotherapy is available.

A malignant retroperitoneal nonchromaffin paraganglioma in a thirty-four-year-old man was studied by light and electron microscopy. Histologically, the tumor cells displayed a tendency to surround granular, eosinophilic intercellular material and to form nests and pseudo-acini. Ultrastructurally, the tumor was composed of moderately well-differentiated epithelial cells intermixed with sparse sustentacular cells. An organoid pattern, reminiscent of the functional anatomic unit of nonchromaffin paraganglia, was seen occasionally. Epithelial cells formed pseudo-acini around dilated microvillous processes. These morphologic features are consistent with the neurocrestal origin of paragangliomas. The patient died ten months after presentation despite an initial favorable response to irradiation.

Clinical and radiographic evaluation of a fifty-six-year-old male with microscopic hematuria led to radical nephrectomy for renal cell carcinoma. Histologic examination by light and electronmicroscopy was most compatible with malignant schwannoma. The tumor was close to the kidney without actual renal involvement. This case is of interest for both its rarity and its unusual presentation.

The pattern of dissemination of prostatic carcinoma varies, but skeletal metastasis is the single most common symptomatic mode of presentation. The clinical course and treatment of the 2 cases presenting with symptomatic metastases to the retroperitoneum are described in detail and pertinent literature is reviewed.

Primary retroperitoneal seminoma is well documented. A case is reported in which a patient presented with a seminoma of testis eighteen years after removal of a retroperitoneal seminoma. Histologic appearance of the testis was identified to the original pathology, and it is proposed that this represents recurrence of an occult testicular seminoma.

A well-differentiated liposarcoma of the retroperitoneum and spermatic cord, contiguous through the inguinal canal, presented clinically as a scrotal mass. Radical orchiectomy was performed with removal of the spermatic cord tumor. The retroperitoneal portion was not discovered until one month postoperatively when a computerized tomographic scan of the abdomen was done. A recommendation is made for preoperative evaluation of the retroperitoneal space prior to extirpation of supratesticular spermatic cord masses.

A case of retroperitoneal benign schwannoma is presented; in addition, 133 cases of retroperitoneal schwannoma reported in Japanese literature are studied. In our series 66 per cent of the cases were found to be cystic. Therefore, the cystic change may be one of the preoperative features of schwannomas, because other types of retroperitoneal tumor do not frequently form cysts. Furthermore, the necessity of postoperative electron microscopy for accurate histologic diagnosis is discussed.

Retroperitoneal neurilemomas are rare tumors. They are usually asymptomatic, grow to a large size, and generally undergo cystic degeneration before they are discovered. There may be a palpable flank mass. Almost invariably excretory urography shosw renal or ureteral deviation, and arteriography usually reveals an avascular mass. We present a brief review of the literature and 2 case reports of suprarenal neurilemoma, a site of occurrence not previously reported. One suprarenal neurilemoma occurred in a two-year-old child. The other was removed from a fifty-two-year-old man, and in this case a thoracoabdominal approach was helpful.

The clinical and pathologic features of benign and malignant retroperitoneal neurilemmoma are reviewed, and the pertinence of this tumor to the urologist is stressed. Two additional case reports are added to the literature.

Patients with retroperitoneal or mediastinal neoplasms of gonadal tissue type and clinically normal testes pose interesting therapeutic dilemmas. Three major groups of patients are recognized: (1) tumor is primary extragenital gonadal neoplasm; (2) occult microscopic primary neoplasm in a testicle with metastases; (3) area of fibrosis in a testicle representing local regression of tumor, but with distant metastases. Review of case reports often indicates lack of data sufficient for classification. Every effort should be made to group patients into proper categories, since treatment will vary. Two patients classified as group 2 are presented.