Retroperitoneal teratoma is uncommon and carries considerable surgical risks. Some preoperative clinical and radiographic features could be predictive of surgical complication risk. We aimed to ...identify surgical risk factors that predicted perioperative complications.
Childhood retroperitoneal teratoma cases operated on at Guangzhou Women and Children's Medical Center were retrospectively reviewed. Demographic features; clinical, laboratory, radiographic, and intraoperative findings; perioperative complications; and pathology results were assessed.
Between May 2000 and December 2017, 152 childhood retroperitoneal teratomas were resected from 102 female patients (median age 5.75 months). Sixty-three patients (41%) experienced perioperative complications (79 intraoperative and 5 postoperative), including kidney excision (4 patients) and adrenal gland excision (1 patient). Among 113 patients with preoperative computed tomography/magnetic resonance images, 112 (99%), 111 (98%), and 113 (100%) demonstrated artery, vein, and organ distortion, respectively, and 28 (25%) had vessels encased by tumors. Patients with perioperative complications had more veins and organs distorted by tumors. In multivariate analysis, the numbers of vessels encased and organs distorted by tumors were significantly associated with perioperative complications (odds ratio = 1.45 and 1.69, 95% confidence interval: 1.00–2.10 and 1.19–2.41, respectively).
Retroperitoneal teratoma resection has a high perioperative complication rate. Teratomas encompassing the vasculature and distorting organs were associated with increased surgical risk. Additional studies aiming to better define the surgical approach to retroperitoneal teratoma are warranted.
III.
Background
Testicular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. ...Current clinical guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis.
Objective
We aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size.
Methods
An 8‐item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group.
Results
In the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (
n
= 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (
p
= 0.224).
Conclusion
Clear and consistent measurement instructions are urgently needed to be present in all guidelines across different specialistic fields involved in testicular cancer management.
Introduction
Synovial sarcoma (SS) is a rare mesenchymal malignant tumor. SS of the spine or retroperitoneum is an extremely rare site. Approximately 30% cases show focal calcifications on ...radiographs and computed tomography (CT) images, while extensive calcification rarely occurs. We presented a case of SS involving the spinal canal and paraspinal muscle and retroperitoneum, which showed extensive calcification on CT.
Clinical presentation
The present report describes the case of a 13-year-old girl suffering from a tumor in the spinal canal and paraspinal muscle and retroperitoneum with extensive calcification on CT. The patient underwent lumbar and retroperitoneal giant tumor resection, lumbar decompression, and spinal tumor resection with a small tumor remnant remaining in the paravertebral region. Histological examination and genetic testing after surgery confirmed synovial sarcoma. After surgery, the patient refused local radiotherapy but agreed to receive chemotherapy. After 4 months of follow-up, her condition was basically stable, and the pain in her left lower limb disappeared. The residual tumor was not increased.
Conclusion
Extensive calcification of SS is rare. The possibility of synovial sarcoma should be considered in those who show extensive calcification in the spinal canal and paraspinal muscle and retroperitoneum on CT. For cases that cannot be completely resected, adjuvant chemotherapy can control the residual tumor in the short term. In addition, the long-term effects need to be observed.
Abstract Background Retroperitoneal lymph node dissection (RPLND) is an important component of the management of testicular germ cell tumor (GCT) but carries significant surgical morbidity. Objective ...To describe our experience with a midline extraperitoneal (EP) approach to RPLND for seminomatous and nonseminomatous GCT. Design, setting, and participants From 2010 to 2015, 122 consecutive patients underwent RPLND from a prospective database. Patients requiring aortic resection or retrocrural dissection or with intraperitoneal disease were excluded. The remaining 69 patients underwent midline EP-RPLND. Surgical procedure Open midline EP-RPLND was performed using a standardized technique. Outcome measurements and statistical analysis Perioperative and long-term outcomes were analyzed. Complications were graded using the Clavien-Dindo classification. A descriptive analysis using SAS software was performed. Results and limitations A total of 68 patients underwent midline EP-RPLND successfully (98.6%). The median age was 28 yr (range 17–55). On preoperative imaging the size of the retroperitoneal mass or lymphadenopathy was <2 cm in 29 patients, 2–4.9 cm in 15 patients, and >5 cm in 24 patients, of which 19 were >10 cm. The median estimated blood loss was 325 ml (interquartile range IQR 200–612.5). The median number of lymph nodes resected was 36 (IQR 24.5–49); the median number of positive nodes was one (IQR 0–4). The median time for return of bowel function was 2 d (IQR 1–2) and hospital stay 3 d (IQR 3–4). There were no cases of ileus. Eleven patients had 12 (17.6%) 90-d complications. Of these, six (55%) were Clavien grade 1, five (45%) were grade 2, and one was grade 3b (1.5%). Antegrade ejaculation rates were 91.6% in the primary group and 96.8% in the post-chemotherapy group. Conclusions Midline EP-RPLND can be performed safely without compromising the completeness of the resection. This approach is associated with rapid return of bowel function, minimal rates of ileus, and short hospital stay. Patient summary A midline extraperitoneal approach for retroperitoneal lymph node dissection in testicular cancer is safe and effective and leads to faster return of bowel function and earlier discharge.
Radiation therapy and systemic chemotherapy are recommended treatment options in marker-negative clinical stage (CS) IIA/B seminoma. Despite high cure rates of 82-94%, both therapeutic options are ...associated with significant long-term toxicities.
To evaluate the feasibility, oncological efficacy, and treatment-associated morbidity of primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) in CS IIA/B seminoma.
A prospective, single-arm, clinical phase 2 trial including CS IIA/B seminoma patients was conducted.
Primary nerve-sparing retroperitoneal lymphadenectomy.
Relapse-free and overall survival, surgery-associated complications according to the Clavien-Dindo classification, and Kaplan-Meier methods for survival calculation were assessed.
Thirty patients at a mean age of 39.1 (34-52) yr with marker-negative CS IIA and IIB seminomas were recruited. The median follow-up was 22 (8-30) mo. Nineteen (63%) and 11 (36%) patients were diagnosed with stages IIA and B, respectively, at the time of primary diagnosis. Fourteen (47%) and 16 (53%) patients were diagnosed with CS IIA and IIB, respectively, at the time of nsRPLND. Twenty-seven and three patients underwent open and robot-assisted nsRPLND, respectively. The median operating room time was 125 (115-145) min, median blood loss was <150 ml, and median time of hospitalization was 4.5 (3-9) d. Four (13%) patients experienced Clavien-Dindo grade 3a complications. Lymph node histology revealed seminoma in 25 (80%) patients; two and three patients demonstrated embryonal carcinoma and benign disease, respectively. Sixteen patients underwent a serum analysis of miR371 preoperatively, which predicted metastatic disease in 12/13 and benign histology in 3/3 patients. Three of 30 (10%) patients developed an outfield relapse 4, 6, and 9 mo postoperatively and were salvaged by systemic chemotherapy. Limitations are the low patient number and length of follow-up.
The nsRPLND approach results in a high cure rate at midterm follow-up and is associated with a low frequency of treatment-associated morbidities, making this approach a feasible alternative to radiation therapy or systemic chemotherapy.
The standard treatment of clinical stage IIA/B seminomas is radiation therapy or chemotherapy, which results in a significantly increased frequency of long-term toxicity and secondary neoplasms. In this trial, we demonstrate that nerve-sparing retroperitoneal lymph node dissection is a feasible therapeutic approach with low morbidity and high oncological efficacy.
Objectives
To evaluate the ability of clinical and radiographic features to predict lymph node (pN1) disease among patients with renal cell carcinoma undergoing radical nephrectomy (RN), and to ...develop a preoperative risk prediction model.
Patients and Methods
In all, 220 patients with preoperative computed tomography scans available for review underwent RN with lymph node dissection (LND) from 2000 to 2010. Radiographic features were assessed by one genitourinary radiologist blinded to pN status. Associations of features with pN1 disease were evaluated using logistic regression to develop predictive models. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and decision curve analysis.
Results
The median (interquartile range) lymph node yield was 10 (5–18). In all, 55 patients (25%) had pN1 disease at RN. On univariable analysis, the maximum lymph node (LN) short axis diameter odds ratio (OR) 1.17; P < 0.001 predicted pN1 disease with an AUC of 0.84. Although several clinical and radiographic features were associated with pN1 disease, only two were retained in the multivariable model: maximum LN short axis diameter (OR 1.19; P <0.001) and radiographic perinephric/sinus fat invasion (OR 44.64; P = 0.01), with an AUC of 0.85. On decision curve analysis, the single variable and multivariable models showed similar net benefit.
Conclusion
Two radiographic features, maximum LN short axis diameter and perinephric/sinus fat invasion, outperformed traditional clinical variables in predicting pN1 disease. Maximum LN short axis diameter alone showed excellent predictive performance, and, if validated externally, would provide for a simple model to guide patient selection for LND.
Background and Aim
The aim of this study was to assess the performance of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) for the diagnosis of gastric linitis plastic (GLP).
Methods
We ...retrospectively reviewed all the cases undergoing EUS for suspected GLP from January 2012 to September 2017. We included patients with GLP confirmed pathologically with white‐light endoscopy (WLE)‐guided biopsy or EUS‐FNA. Diagnostic value of WLE biopsy and EUS‐FNA was further analyzed.
Results
A total of 107 cases of suspected GLP were referred for EUS examination in our center. Twenty‐six patients were eligible and included. GLP was confirmed in 15 cases by EUS‐FNA, nine cases by WLE biopsy, and eight cases by surgical pathology. The positive rate of EUS‐FNA and WLE biopsy for involved gastric wall was 71.43% (15/21) and 47.37% (9/19). EUS‐FNA of metastatic lymph nodes was also performed in 16 cases, and 15 (93.75%) were proved to be malignant, including all 13 that were positive for peri‐gastric lymph nodes, and two of three (66.67%) that were positive rate for retroperitoneal lymph nodes. Diameters of punctured lymph nodes ranged from 3.30 to 22.70 mm, with an average of 12.12 mm.
Conclusions
Pathological diagnosis of GLP by invasive endoscopy is still intractable, even at a late stage. Positive results can be obtained even in small or distant lymph nodes.
Mullerian duct cysts are considered to be part of the urogenital cysts. Mullerian cysts, anatomically distant to the genitourinary organs or the pelvis, are extremely rare entities.
Case report and ...review of the literature using key word "Mullerian cyst", "retroperitoneal" and "mediastinal".
A 48-year-old woman with abdominal discomfort and nausea was referred to our hospital. Further work-up with CT and MRI showed a large retrogastric, retropancreatic cyst, herniating through the diaphragm in the mediastinum. As etiology was unsure, a laparoscopic cystectomy was performed. Histological examination showed a benign cyst of Mullerian origin. A review of the literature confirmed that extrapelvic Mullerian cysts are rare, with only 28 mediastinal cysts and 12 extrapelvic retroperitoneal cysts being described.
Retroperitoneal Mullerian cysts outside the pelvis have infrequently been described in the literature. As correct preoperative diagnosis is seldom possible, surgical resection is the gold standard of treatment.
