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Overview
The incidence of retroperitoneal malignant tumors is high, about 4 times that of benign tumors. The most common retroperitoneal benign tumors are neurogenic tumors, followed by teratoma . However, retroperitoneal malignant tumors are very rare, accounting for approximately 0.1%-0.2% of all malignant tumors. At the same time, appendiceal tumors are rare, and appendiceal lesions usually manifest as appendicitis . Today, let’s learn about a case of appendiceal tumor that passed through the retroperitoneum.
Case Description
html Eleven 68-year-old men were hospitalized for treatment due to weight loss for 6 months, progressive abdominal distension and abdominal pain for 2 weeks. The patient does not have any underlying diseases. At the same time, he does not have neurological symptoms, fever, hematuria, gastrointestinal bleeding, constipation, etc. Physical examination revealed significant periumbilical abdominal distension and a palpable mass that expanded to the right side without tenderness. Abdominal and pelvic CT showed that the right kidney was normal; there was a cystic lesion in the right retroperitoneum, which had a multicystic appearance and infiltrated the right psoas muscle, extending to the lower abdomen and right pelvic level, and at the same time, squeezing the adjacent area of bladder (Figure 1).Figure 1. CT Shown
On the third day of admission, the patient underwent exploratory laparotomy due to intractable abdominal pain. Laparotomy was performed through a midline incision, and after incision of the linea alba, the right retroperitoneum was explored. During surgery, the appendix tumor was found to have invaded the peritoneum. Subsequently, the appendix was dissected from the retroperitoneum, dissociated, and excised. A right hemicolectomy was performed from the ileocecal valve 10cm to the middle of the transverse colon, and an ileocolic anastomosis was performed. Additionally, the collected multilocular mucus and resected tissue were sent to the pathology laboratory. The postoperative pathology results showed that the tumor size was 4×2.5×1cm, the tumor type was mucinous appendiceal tumor, and no lymph node metastasis was found (Figure 2).
Figure 2. Pathological results show
The patient recovered well after surgery and was discharged from the hospital on the 10th day.
Summary
For retroperitoneal masses, physicians should consider several conditions, such as invasive peritoneal tumors such as appendiceal tumors. Detailed preoperative examination and timely surgical treatment, including open surgery and laparoscopy, can accurately diagnose and reduce complications. At the same time, retroperitoneal masses with gastrointestinal symptoms may require some other tests, such as MRI and colonoscopy.
Reference:
1. Salehipour M, Haghpanah A, Dehghani A, Roozbeh J, Amirian A, Moein Vaziri N, Kiani S. Retroperitoneal mass, a rare manifestation of mucinous adenocarcinoma of appendix: A case report. Clin Case Rep. 2022 Nov 19;10(11):e6602. doi: 10.1002/ccr3.6602. PMID: 36415704; PMCID: PMC9675359.
