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RESUMEN Objetivo: reportar el caso de una paciente gestante con diagnóstico de tumor retroperitoneal primario y hacer revisión de la literatura del diagnóstico, tratamiento y pronóstico materno-fetal de esta entidad durante el embarazo. Materiales y métodos: gestante de 19 años que consulta por tumor retroperitoneal identificado por ecografía, se realizó biopsia percutánea con resultado de tumor benigno; parto por cesárea con recién nacido sano. A los 4 meses se realizó resección quirúrgica, la histopatología mostró un teratoma quístico maduro. Se realizó búsqueda en las bases de datos de: Medline vía PubMed, Lilacs, SciELO y ScienceDirect, con los términos: “embarazo”, “neoplasias” y “neoplasias retroperitoneales”, incluyendo reportes y series de caso de tumores retroperitoneales en el embarazo. Se identificó el diagnóstico, tratamiento y pronóstico materno-fetal Resultados: se identificaron 1.658 títulos, de los cuales 34 reportes de casos y una serie de casos cumplieron con los criterios de inclusión. El 62,9 % eran tumores benignos. El diagnóstico se hizo como hallazgo incidental en el 63 % de los casos, el ultrasonido identificó la masa en el 77 %, la biopsia percutánea se utilizó en el 8 % de los casos incluyendo el reportado. El tratamiento quirúrgico fue utilizado en el 88 % de los casos, generalmente después del parto. Hubo mortalidad materna en el 8,5 % de los casos. El pronóstico fetal fue bueno en el 65 % de las gestaciones. Conclusión: los tumores retroperitoneales en la gestación, a pesar de ser principalmente benignos, tienen un pronóstico materno y fetal reservado en un importante número de casos. Se requiere evaluar los beneficios y riesgo de la biopsia percutánea. ABSTRACT Objective: To report the case of a pregnant patient diagnosed with a primary retroperitoneal tumor and to conduct a review of the literature pertaining to the diagnosis, treatment and maternal-fetal prognosis of this disease condition during pregnancy. Materials and methods: A 19-year-old patient who presented with a retroperitoneal tumor identified on ultrasound. The results of the percutaneous biopsy showed a benign tumor. A healthy neonate was delivered by cesarean section. Surgical resection was performed four months later, and histopathology showed a mature cystic teratoma. A search was conduced in the Medline via PubMed, Lilacs, SciELO and ScienceDirect databases using the terms “pregnancy,” “neoplasms,” and “retroperitoneal neoplasms,” including case reports and case series of retroperitoneal tumors during pregnancy. Diagnosis, treatment and maternal-fetal prognosis were identified. Results: Overall, 1658 titles were identified. Of these, 34 case reports and 1 case series met the inclusion criteria. Of the cases, 62.9 % were benign. Diagnosis was made as an incidental finding in 63 % of cases, and 77 % of the masses were identified on ultrasound. Percutaneous biopsy was used in 8 % of cases, including the case reported here. Surgical treatment was used in 88 % of cases usually after delivery. Maternal mortality occurred in 8.5 % of cases. Fetal prognosis was good in 65 % of the pregnancies. Conclusion: Despite being frequently benign, retroperitoneal tumors during gestation have a reserved maternal and fetal prognosis in a substantial number of cases. There is a need to assess the risks and benefits of percutaneous biopsy.

El tumor fibroso solitario es una neoplasia fuso celular, poco común de localización pleural frecuentemente. Presentamos un caso de presentación crónica evidenciándose masa palpable identificando tumoración de 35 x 20 x 15 cm. Diagnosticándose por anatomía patológica tumor fibroso solitario gigante (TFSG). En la revisión bibliográfica sobre los tumores diagnosticados como TFSG es muy infrecuente, siendo el primero reportado en nuestro medio. Giant solitary fibrous tumor (TFSG) is a spindle cell neoplasm, uncommon, being pleural a common site. We report a case of chronic presentation of 4 months duration with a palpable mass. We found, a tumor 35 x 20 x 15 cm .In the literature tumors diagnosed as TFSG are very rare, the first reported in our country.

Los teratomas retroperitoneales constituyen el 3% del total de tumores en la población pediátrica. Sin embargo, en Colombia no existe un registro que soporte esta cifra, ni consenso sobre su diagnóstico, tratamiento y pronóstico. Se presenta un caso en una recién nacida en la ciudad de Bucaramanga, Colombia, diagnosticado por imágenes y tratado quirúrgicamente. Se revisa la literatura al respecto incluyendo los aspectos generales, el diagnóstico diferencial, las características histológicas y el tratamiento, con el fin de orientar al médico para que considere esta posibilidad diagnóstica. Retroperitoneal teratomas constitute 3% of all pediatric tumors. However, no information is available in Colombia to support this frequency, and there is no consensus on the diagnosis, management and prognosis of this tumor. We report a case in a newborn girl in Bucaramanga, Colombia, diagnosed by means of imaginological studies and treated by surgery. We review the literature, considering general aspects, differential diagnosis, histological features and management, in order to guide physicians to consider this diagnostic possibility.

Los sarcomas originados en las paredes de los grandes vasos son tumores de escasa presentación. El leiomiosarcoma de la vena cava es una enfermedad compleja que requiere ser manejado por un grupo multidisciplinario. Su tratamiento es quirúrgico. Poco se conoce de sus resultados oncológicos. Se presenta el caso de una paciente de 56 años, con diagnóstico de leiomiosarcoma de la vena cava inferior, su evaluación, manejo quirúrgico y seguimiento a corto plazo. Se hace una revisión de la literatura existente hasta la fecha, evaluando además la fisiopatología y la necesidad de reconstruir la vena cava inferior. Sarcomas Sarcomas originating in the walls of the large vessels are tumors of unusual presentation. Leiomyosarcoma of the vena cava is a complex disease that needs to be managed by a multidisciplinary team. Its management is surgical. Little is known of their oncologic results. We report the case of a 56 year-old patient, diagnosed with leiomyosarcoma of the inferior vena cava, including her evaluation, surgical management, and short-term follow-up. An updated review of the literature is presented, along with an evaluation of the pathophysiology and the need for reconstruction of the inferior vena cava.

El hemangiopericitoma es un tumor infrecuente de origen vascular que deriva de los pericitos de Zimmerman. Representa aproximadamente un 1% de todos los tumores vasculares. En el momento del diagnóstico, establecer el potencial de malignidad de este tipo de tumoración es algo habitualmente controvertido. El pronóstico se basará en el patrón histológico y en la evolución clínica, siendo la aparición de recurrencias locales o de metástasis a distancia los únicos signos definitivos de malignidad. El caso de un paciente de 61 años con un hemangioperictoma retroperitoneal de gran tamaño nos sirve para revisar los aspectos clínicos y patológicos, el tratamiento y los factores pronósticos de esta rara neoplasia. Hemangiopericytoma is a rare tumour of vascular origin derived from Zimmermann's pericytes. It represents approximately 1% of all vascular tumours. At the time of diagnosis, determining the malignant potential of this type of mass is usually controversial. Prognosis will be based on histological patterns and the clinical course, with the appearance of local recurrences or distant metastases being the only definitive signs of malignancy. The case of a 61 year old patient with a very large retroperitoneal hemangiopericytoma serves to review clinical and pathological aspects, treatment and prognostic factors of this rare neoplasm.

Introducción. El abordaje transperitoneal es la técnica más utilizada para la resección de los tumores retroperitoneales. El abordaje extraperitoneal podría ser una alternativa viable para pacientes seleccionados, que no se ha descrito ni evaluado en estudios clínicos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, retrospectivo, de los resultados de dos abordajes para los tumores retroperitoneales: transperitoneal y extraperitoneal. Se revisaron manualmente todas las historias consecutivas de los pacientes con diagnóstico de tumor retroperitoneal, intervenidos quirúrgicamente en el Hospital Pablo Tobón Uribe, desde enero de 2003 hasta marzo de 2011. Resultados. Se evaluaron 37 abordajes, 16 transperitoneales, 19 extraperitoneales y 2 combinados. En 59 % de los pacientes se obtuvo resección R0 (50 % abordaje transperitoneal Vs. 68 % abordaje retroperitoneal). El tiempo quirúrgico promedio fue de 152,96 minutos (159,8 Vs. 134,5). En general, los pacientes no requirieron transfusión de hemoderivados (56,3 Vs. 78,9 %). El 30 % de los paciente presentó complicaciones posoperatorias (25 % Vs. 31,6 %). Hubo una muerte intraoperatoria durante un procedimiento con abordaje extraperitoneal. Discusión. El abordaje extraperitoneal para los tumores retroperitoneales es una técnica nueva. Se requieren más estudios al respecto para aclarar adecuadamente su papel en la resección de los tumores retroperitoneales. Introduction: The most common technique for resection of retroperitoneal tumors it is by far the transperitoneal approach. The extra peritoneal approach could be a viable alternative for selected patients, but it has not been described nor evaluated in clinical trials. Material and methods: This is a retrospective and descriptive study in which we analyzed the results for the two different approaches for retroperitoneal tumors. The clinical records of all patients with the diagnosis of retroperitoneal tumor that were operated at Hospital Pablo Tobón Uribe during a period of time between January 2003 and March 2011 were reviewed manually. Results: Of a total of 37 surgical procedures, 16 were transperitonal, 19 extraperitoneal and two of them required a combined approach. 59% had a resection graded as R0 (50% with the trans peritoneal approach and 68% with the retroperitoneal approach).The mean operating time was 152.96 minutes (159.8 vs. 134.5, respectively). Most of the patients did not need blood transfusion (56,3 vs 78,9%).The complication rate was 30% (25% vs. 31.6%). One patient that died during an extraperitoneal approach operation. Discussion: The extraperitoneal approach is a new a new technique for the resection of retroperitoneal tumors. More studies are required before a full recommendation favoring this technique can be stated.

El rabdomiosarcoma es un tumor maligno de los tejidos blandos que representa, aproximadamente, 4 a 8 % de los tumores sólidos en los niños. Generalmente, se origina en la cabeza y el cuello, y el sistema genitourinario. El rabdomiosarcoma retroperitoneal rara vez se ha reportado en la literatura científica, y el rabdomiosarcoma embrionario de origen epiploico en los adultos es aún más raro. Este tumor maligno de tejidos blandos es más común en los niños. El número de casos por millón de habitantes entre 1994 y 2005, fue de 8,3 (hombres) y 3,7 (mujeres); la mayoría de los casos son esporádicos. Según el tipo histológico, son tumores embrionarios, alveolares o pleomórficos. El rabdomiosarcoma embrionario se llama así por su parecido con el músculo esquelético inmaduro y representa el 60 % de los casos de este tumor en los pacientes menores de 20 años de edad. El propósito de este artículo fue revisar la literatura científica y presentar un caso clínico de rabdomiosarcoma retroperitoneal en un paciente adulto de la Clínica Universitaria Colombia. Rhabdomyosarcoma is a malignant soft tissue tumor accounting for approximately 4-8% of all solid tumors in children. It generally originates in the head and neck and in the genitourinary system. Retroperitoneal rhabdomyosarcoma has been rarely reported in the literature, and the embryonary rhabdomyosarcoma of omental origin in the adult is even rarer. This soft tissue malignancy is more common in children. The number of cases per million inhabitants was 8.3 (males) and 3.7 (females) in the period between the years 1994 and 2005; most cases are sporadic rhabdomyosarcomas. According to the histologic type, these neoplasms are embryonal, alveolar, and pleomorphic. The embryonal rhabdomyosarcoma is named so for its resemblance to the immature skeletal muscle, and represents 60% of all rhabdomyosarcomas in patients under 20 years of age. The purpose of this article is the review of the scientific literature and the report of a case of retroperitoneal rhabdomyosarcoma in an adult managed at Clínica Universitaria Colombiana, Bogotá, Colombia.

Background: Retroperitoneal schwannoma is an uncommon and usually benign condition. We report a 51-year-old woman presenting with a palpable pelvic tumor. The patient was operated on and during the intervention, two retroperitoneal tumors were found and resected. The postoperative course was favorable. Pathology confirmed the diagnosis of retroperitoneal benign shwannomas. After eight years of follow up, there is no evidence of malignant transformation.

El cistoadenocarcinoma primario retroperitoneal es una enfermedad excepcional, siendo este el primer caso publicado en la literatura nacional. Su diagnóstico, en la totalidad de los casos comunicados, es anatomopatológico luego del estudio definitivo de la pieza. Es debatida la extensión de la resección quirúrgica en caso de no existir compromiso de estructuras vecinas. El tratamiento adyuvante se justifica cuando se produce la rotura de la tumoración o existe compromiso locorregional. Se presenta el caso clínico de una paciente de 29 años que consultó por dolor en flanco derecho, en la cual se constató una tumoración a dicho nivel. Tomográficamente se confirmó la existencia de un proceso quístico, al cual se le realizó la excéresis quirúrgica completa junto a un sector de pared abdominal. El informe de anatomía patológica confirmó un cistoadenocarcinoma primario retroperitoneal. No se realizó tratamiento adyuvante, presentando buena evolución a 11 meses de la cirugía, sin evidencias de enfermedad Summary Primary retroperitoneal cystoadenocarcinoma is an exceptional disease, being this the first case Publisher in the national literature. Diagnosis, in all of the cases reported is anatomopathological, subsequent to the final study of the sample. Surgical resection extension is debated if there is no compromise of neighboring structures. Adjuvant treatment is justified when the tumor is broken or there is locoregional compromise. We present the clinical case of a 29 year old patient who consulted for right lank pain, where a tumor was identified. Ultrasound confirmed the existence of a cystic process, and complete surgical abscission/exeresis was performed next to an area in the in the abdominal wall. Anatomopathological report confirmed a primaruy retroperitoneal cistoadenocarcinoma. No adjuvant treatment was applied, evolution was good 11 months after surgery, no evidence of the disease. Résumé Le cystadénocarcinome primaire rétro péritonéal est une maladie rare ; il s’agi donc du premier cas publié dans le pays. Son diagnostic, dans la plupart des cas rapportés, est anatomopathologique après l’étude de la pièce. L’extension de la résection chirurgicale, en cas de non engagement des structures voisines, en est polémique. Le traitement adjuvant est justifié en cas de rupture de la tumeur ou d’engagement locorégional. On présente le cas clinique d’une patiente de 29 ans qui a consulté par douleur au côté droit où une tumeur fut constatée. La tomographie confirme l’existence d’un processus kystique qui subit l’exérèse chirurgicale complète ainsi qu’un secteur de la paroi abdominale. Le rapport d’anatomie pathologique confirme un cystadénocarcinome primaire rétro péritonéal. Après onze mois de la chirurgie, l’évolution est bonne, sans traitement adjuvant ni signes de la maladie. Resumo O cistoadenocarcinoma primário retroperitoneal é uma doença rara, sendo este o primeiro caso publicado na literatura nacional. Em todos os casos publicados seu diagnóstico foi realizado por anatomia patológica do exame definitivo do material. A extensão da resecção cirúrgica quando não se observa compromisso das estruturas próximas é motivo de debate. O tratamento adjuvante é justificado quando há ruptura do tumor ou se registra compromisso regional. Descreve-se o caso clínico de uma paciente de 29 anos que consultou por dor no flanco direito onde se constatou a presença de uma tumoração. Uma tomografia computada confirmou a existência de um processo cístico, que foi ressecado completamente juntamente com um setor da parede abdominal. O exame de anatomia patológica confirmou um cistoadenocarcinoma primário retroperitoneal. A paciente não recebeu tratamento adjuvante apresentado boa evolução 11 meses depois da cirurgia, sem evidências de patologia.

Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and ¡eiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal andpericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery

Background: In large series, nearly 60% of admissions for suspected acute coronary syndrome (ACS) had a non-coronary etiology of the pain. However, short term mortality of non recognized ACS patients, mistakenly discharged from the emergency room is at least twice greater than the expected if they would had been admitted. The concept of a chest pain unit (CPU) is a methodological approach developed to address these issues. Aim: To evaluate the efficacy of a CPU in the emergency room of a general hospital for evaluation of acute chest pain. Material and Methods: Prospective study of patients with chest pain admitted in the CPU. After a clinical, electrocardiographic and laboratory evaluation with cardiac injury serum markers, patients were stratified in three risk groups, based on the likelihood of ACS of the American Heart Association. High probability patients were admitted to the Coronary Unit (CU) for treatment. Moderate probability patients remained in the CPU for further evaluation and low probability patients were discharged with telephonic follow-up. Results: Of 407 patients, 35, 30 and 35% were stratified as high, intermediate and low probability ACS, respectively. Among patients admitted with high probability, 73% had a confirmed ACS diagnosis. Among intermediate probability patients, 86% were discharged after an evaluation in the CPU without adverse events in the follow-up. Conclusion: Structured risk evaluation approach in a CPU improves the management of acute chest pain, identifying high probability patients for fast admission and start of treatment in a CU and allowing safe discharge of low probability ones

We report a 57 year-old woman with a big partially cystic adrenal pheochromocytoma presenting with high fever and abdominal pain. Based on CT scan images and before knowing urinary catecholamines level, the diagnosis of sepsis secondary to an abscessed adrenal macrotumor was done. A diagnostic percutaneous fine-needle puncture and aspiration was done and antibiotic therapy was started. One week later an open surgical drainage and installation of percutaneous drainage tubes was carried out. Both procedures were uneventful and the patient improved dramatically. Three months later a definitive excision surgery was done. After 14 months of follow up, the patient is in excellent conditions and her abdominal CT scan is normal

We report a 57 year-old woman with a big partially cystic adrenal pheochromocytoma presenting with high fever and abdominal pain. Based on CT scan images and before knowing urinary catecholamines level, the diagnosis of sepsis secondary to an abscessed adrenal macrotumor was done. A diagnostic percutaneous fine-needle puncture and aspiration was done and antibiotic therapy was started. One week later an open surgical drainage and installation of percutaneous drainage tubes was carried out. Both procedures were uneventful and the patient improved dramatically. Three months later a definitive excision surgery was done. After 14 months of follow up, the patient is in excellent conditions and her abdominal CT scan is normal.

Se presenta un caso de schwannoma benigno retroperitoneal como hallazgo incidental en una joven de 23 años tratada de un tumor de Wilms a los tres años. Se incluye una revisión de la literatura de este tumor tan infrecuente. We report a case of benign retroperitoneal schwannoma diagnosed casual in a 23 years old woman treated of a Wilm's tumour twenty years ago. A review of the on this unusual tumour is included.