Title: Primary Retroperitoneal Mass­---­­ A CT Overview with FNAC /Histopathological Correlation­­

Author: Dr Krishna Kumar Borah, Dr Arjun Prakash, Dr Aditi Sarma

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i1.40

Abstract

Describe and characterize specific CT imaging finding in varieties of Primary Retroperitoneal masses.

To confirm the diagnosis of CT by FNAC / histopathological correlation.

Material & Method:A hospital based cross sectional study was conducted over a period of 1 year between 1st July 2012 to June 0th 2013 on 67 patients in the deptt. of Radio-Diagnosis, Assam Medical College and Hospital, Dibrugarh. Approved was obtained from the Institutional ethics review committees.

All the patients CT on of abdomen are done both initial unenhanced CT followed by contrast CT scan by giving parenterily Iodinated low osmolar non ionic contrast media. Delayed scan were also obtain wherever necessary. Based on the findings observed on the CT Scan, a probable diagnosis was given, which was confirmed by Fine Needle Aspiration Cytology (FNAC) or by Histopathological examination (HPE) of the operative specimens.

Result:Primary Retroperitoneal tumours accounted for 40.3% of the masses and secondary retroperitoneal masses (arising from retroperitoneal organs) accounted for 59.7%  in this studies. Most of the primary retroperitoneal neoplasm were malignant accounting 78%. 22% of the masses were benign. Among the primary retroperitoneal masses lymphoma accounted 38% followed by liposarcoma 19% and leiomyosarcoma 14.%. nodes (100%). Among the retroperitoneal soft tissue sarcomas, liposarcoma 33.4% was commonest followed by leiomyosarcoma 25% and malignant fibrous Histiocytoma (16.7%).

Conclusion: CT with its fast scanning times and good spatial resolution and multiplanar reconstruction capability is a better imaging modality for characterizing retroperitoneal masses and detecting the organ of origin. Most of the CT diagnoses were correlated with FNAC/HPE diagnosis.

Key words: CT, Retroperitoneal masses, FNAC, HPE.

References

1.      Haaga RH. Dogra VS. Forsling M. Gilkcson RC. Ha HK, Sundaram M. CT and MRI of the whole body 5th Mosby; 2009:1953-2020.

2.      Meyer’s MA. Van Leeuwen MS, Feldberg MA, et al. The extraperitoneal spaces: Normal and pathological anatomy. Dynamic Radiology of the abdomen, 5th ed. New York. Springer, 2000.

3.      Prabhakar Rajiah, Rakesh Sinha, Carlos Cuevas, Theodore J. Dubinsky, et al. Adrenal Mass Imaging with Multidetector CT: Pathologic Conditions. Pearls. and Pitfalls: Radio Graphics 2009;29:1333-51.

4.      David H. Stephens, Patrick F: Sheedy, Robert R. Hattery, and Byrn Williamson, Jr. Diagnosis and evaluation of retroperitoneal tumours by CT. Am  J Roentgenol. September 1977;129:395-402.

5.      Pamela T. Johnson, Karen M. Horton, Elliot K. Fishman, Adrenal Mass Imaging with Multidetector CT: Pathologic Conditions, Pearls, and Pitfalls. Radio Graphics 2009, 29:1333-1351.

6.      Yuki Tomozawa, Yoshitaka Inaba, Hidekazu Yamaura, Yozo Sato, et al. Clinical Value of CT- Guided Needle Biopsy for Retroperitoneal Lesions. Korean J Radiol 2011; 12(3):351-7.

7.      Muhammad Sharif, Umar Farooq, Fawad Mumtaz, et al. Retroperitoneal tumours in children-experience at Mayo Hospital, Lahore Bak J Med Health Sci Mar 2007; 1(1):11-3.

8.      Ingo Alldinger, Qin Yang, Christian Pilarsky, Hans-Detley Saeger, et al. Retroperitoneal Soft Tissue Sarcomas: Prognosis and Treatment of Primary and Recurrent Disease in 117 Patients. Anticancer research. 2006; 26:1577-82.

9.      Thijs van Dalen, Jan-Willem W. Coebergh, Mariel K. Casparie, Charles H.F. Gimbrere, et al. Soft Tissue Sarcoma: The Predominant Primary Malignancy in the Retroperitoneum. Sarcoma. 2001; 5(1): 5-8.

10.  Hayasaka K, Yamada T, Saitoh Y, Yoshikawa D, et al. CT evaluation of primary  benign retroperitoneal tumor. Radiation Medicine. 1994 May-Jun; 12(3):115-20.

11.  Netfeld JP, Walsh JW, Lawrence W Jr. Computed tomography in the management of soft tissue tumors. Surg Gynecol Obster. 1982 Oct. 155(4):535-40.

12.  Joseph K.T. Lee, Robert J. Stanley, Stuart S. Sagel, and Robert G. Levitt. Accuracy of Computed Tomography in detecting intraabdominal and pelvic adenopathy in lymphoma. Am J Roentgenol 1978; 131:311-315.

13.  Sun Hwa Honga, Kyeong Ah Kima, Ok Hee Woo…. et al. Dedifferentiated  liposarcoma of retroperitoneum: Spectrum of imaging findings in 15 patients. Clinical Imaging; 2010; 34:203-210.

14.  Dieckmann C, Habermann CR, Zornig C, Beese M, Nicolas V Aktuelle. Computerized tomography of retroperitoneal liposarcoma. Aktuelle Radiol: 1997 Jan; 7(1):23-9.

15.  David S. Hartmen, W S Hayes, P L Choyke, and G P Tibbetts. Leiomyosarcoma of the Retroperitomeum: Criteria for and Inferior Vena Cava: Radiologic and pathologic-Correlation; Radio Graphics 1992; 12: 1203-1220.

16.  McLeod AJ, Zornoza J, Shirkhoda A. Leiomyosarcoma: Computed tomographic finding Radiology. 1984 Jul; 152(1):133-6.

17.  Bivek Karki, Yi-Kai Xu, and Wei-Wei Zhang. Primary malignant fibrous histocytoma of the abdominal cavity: CT findings and pathological correlation. World J Radiol 2012 April 28; 4(4): 151-158.

18.  Thierry Peycru, J Guiramand, Eric Tardat, P. H. Savoie, et al. nodular ganglioneuroblastoma in adults, Can J Surg; August 2009; 52(4):111-3.

19.  Kk Sabharwal, Al Chauhan, A Taterh. Retroperitoneal Ganglioneuroblastoma in an Adult with intratumoral bleed. Indian J Radiol Imag. 2006; 16:2:193-196.

20.  Sung Eun Rha, Jac Young Byun, Seung Eun Jung, Ho Jong Chun, et al. neurogenic Tumors in the Abdomen: Tumor Types and Imaging Characteristics, Radio Graphics 2003; 23:29-43.

21.  Ruppert David, F Eftekhari, T N Lamki, A Shirkhoda, et al. The many faces of Neuroblastoma, Radio Graphics; September 1989: 9 (5): 859-82.

22.  Ali Kamalati and Hamid Tabrizchi. Simultaneous right retroperitoneal schwannoma and left renal hydatid cyst, case Reports in Urology. 2013.

23.  Qiang Li, Chuntao Gao, Jonathan T. Juzi, Xishan Hao. Analysis of 82 cases of Retroperitoneal Schwannoma . ANZ Journal of Surgery. April 2007; 77(4):237-240.

24.  Davidson AJ, Hartman DS, Golman SM. Mature teratoma of the retroperitoneum radiologic, pathologic, and clinical correlation. Radiology. 1989 Aug; 172(2):421-5.

25.  Changhoon Yoo, Jeong-Eun Kim, Shin-Kyo Yoon, Song Cheol Kim, et al. Angiosarcoma of the Retroperitoneum: Report on a Patient Treated with Sunitinib. Sarcoma 2009; 1-4.

26.  K Taori, Patil, V Attarde, S Chandanshive, et al. Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma: A Computed Tomography diagnosis. Brit J Radiol 2007; 80(959):278-70.

27.  Abdulmajeed R. Alhazzani, Mohamed Sherif El-sharkawy and Hamdy Hassan. Primary retroperitoneal synovial sarcoma in CT and MRI. Urol Ann. 2010 Jan-Apr; 2(1): 39-41.

28.  Akhtar Murtaza, Chandak Kanhaiya, Mahore Sadhna, Maimoon Sabiha. Fetus in Fetu: A Rare Presentation in an Adult Female. OMJ 2010; 25:43.

Corresponding Author

Dr Krishna Kumar Borah

Assoc. Prof. Radio- Diagnosis TMCH Assam

(Formarly Assoc. Prof. AMCH Dibrugarh)