Multidetector Computed Tomographic Characterization of a Rare Retroperitoneal Mass in the Left Psoas Compartment

Abstract

We discuss a case of a rare, large, left-sided retroperitoneal mass that presented a diagnostic difficulty in characterization both radiologically and pathologically. We analyze the imaging findings in a step-by-step manner to understand its structure of origin, components, and tissue characterization. Intraoperative images are correlated with multidetector computed tomographic (CT) scan images to demonstrate spatial orientation. A discussion of the pathological findings, and conclusions are made. This discussion highlights the methodology by which radiologic diagnosis is made on multidetector CT scans.

Keywords - multidetector computed tomography - primary ureteric sarcoma - retroperitoneal sarcoma - transitional cell carcinoma - psoas sarcoma - psoas space - retroperitoneum

• References

• 1 Ishikawa K, Nakao S, Nakamuro M, Huang TP, Nakano H. The retroperitoneal interfascial planes: current overview and future perspectives. Acute Med Surg 2016; 3 (03) 219-229
• 2 Coffin A, Boulay-Coletta I, Sebbag-Sfez D, Zins M. Radioanatomy of the retroperitoneal space. Diagn Interv Imaging 2015; 96 (02) 171-186
• 3 Lenchik L, Dovgan DJ, Kier R. CT of the iliopsoas compartment: value in differentiating tumor, abscess, and hematoma. AJR Am J Roentgenol 1994; 162 (01) 83-86
• 4 Messiou C, Moskovic E, Vanel D. et al. Primary retroperitoneal soft tissue sarcoma: imaging appearances, pitfalls and diagnostic algorithm. Eur J Surg Oncol 2017; 43 (07) 1191-1198
• 5 Behranwala KA, A'Hern R, Thomas JM. Primary malignant tumors of the iliopsoas compartment. J Surg Oncol 2004; 86 (02) 78-83
• 6 Gopalakrishnan KC. Natural “barriers” its relevance to the spread of bone sarcoma. J Bone Soft Tissue Tumors 2015; 1 (02) 5-9
• 7 Gladdy RA, Gupta A, Catton CN. Retroperitoneal sarcoma: fact, opinion, and controversy. Surg Oncol Clin N Am 2016; 25 (04) 697-711
• 8 Griffin JH, Waters WB. Primary leiomyosarcoma of the ureter. J Surg Oncol 1996; 62 (02) 148-152
• 9 Lin WR, Yang S, Lo KY, Chang KM. Primary leiomyosarcoma of the ureter. 中華民國泌尿科醫學會雜誌 2000; Sep 1 11 (03) 138-41
• 10 Shirotake S, Sumitomo M, Asakuma J, Asano T, Aiko S, Hayakawa M. [A case of primary leiomyosarcoma of the ureter] [in Japanese]. Hinyokika Kiyo 2006; 52 (01) 41-45
• 11 Cho KH, Hyun JH, Chung HY, Chang YS, Han DS. Primary leiomyosarcoma of the ureter. Korean J Urol 2007; 48 (11) 1174-1178
• 12 Lv C, Chen N, Zhu X, Zhang X, Zhong Z. Primary leiomyosarcoma of the ureter. Asian J Surg 2008; 31 (04) 191-194
• 13 Aubert E, Millet I, Serre I, Taourel P. Leiomyosarcoma of the ureter: a rare case. Diagn Interv Imaging 2012; 93 (01) 60-63
• 14 Shastri RK. Primary leiomyosarcoma of the ureter, a case report. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2016; 15 (05) Ver. VIII 59-63
• 15 Busuttil G, Bonello F, Mattocks S. Leiomyosarcoma of the distal ureter: a case report. Malta Med J 2016; 28 (04) 55-57
• 16 Minami M, Ohmoto K, Charnsangavej C, Kawauchi N, Itai Y, Sasaki S. Origin of abdominal tumors: useful findings and signs on tomographic imaging. (abstr) Radiology 1996; 201 (P) 491
• 17 Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush Jr WH, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics 2011; 31 (04) 949-976
• 18 Nishino M, Hayakawa K, Minami M, Yamamoto A, Ueda H, Takasu K. Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues. Radiographics 2003; 23 (01) 45-57
• 19 Kim MS, Kim B, Park CS. et al. Radiologic findings of peripheral primitive neuroectodermal tumor arising in the retroperitoneum. AJR Am J Roentgenol 2006; 186 (04) 1125-1132
• 20 Brennan C, Kajal D, Khalili K, Ghai S. Solid malignant retroperitoneal masses-a pictorial review. Insights Imaging 2014; 5 (01) 53-65
• 21 Atasoy C, Yağci C, Fitoz S, Sancak T, Akyar G, Akyar S. Cross-sectional imaging in ureter tumors: findings and staging accuracy of various modalities. Clin Imaging 2001; 25 (03) 197-202
• 22 Cheong IJ, Cha SH, Cha SH, Kim SH, Kim DS, Kim AR. Exophytic growth of ureteral transitional cell carcinoma as a cause of retroperitoneal tumor: a case report. J Korean Radiol Soc 2000; 43 (01) 87-89
• 23 Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993; 217 (01) 72-77
• 24 Winalski CS, Lipman JC, Tumeh SS. Ureteral neoplasms. Radiographics 1990; 10 (02) 271-283