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01-03-2021 | Liposarcoma | Review

Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know

Authors: Ferenc Czeyda-Pommersheim, Christine Menias, Annemarie Boustani, Margarita Revzin

Published in: Abdominal Radiology | Issue 3/2021

Abstract

Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis.

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Mota M, Bezerra ROF, Garcia MRT (2018) Practical approach to primary retroperitoneal masses in adults. Radiol Bras 51 (6):391-400. https://doi.org/10.1590/0100-3984.2017.0179CrossRefPubMedPubMedCentral

Goenka AH, Shah SN, Remer EM (2012) Imaging of the retroperitoneum. Radiol Clin North Am 50 (2):333-355, vii. https://doi.org/10.1016/j.rcl.2012.02.004

Elsayes KM, Staveteig PT, Narra VR, Chen ZM, Moustafa YL, Brown J (2007) Retroperitoneal masses: magnetic resonance imaging findings with pathologic correlation. Curr Probl Diagn Radiol 36 (3):97-106. https://doi.org/10.1067/j.cpradiol.2006.12.003CrossRefPubMed

Scali EP, Chandler TM, Heffernan EJ, Coyle J, Harris AC, Chang SD (2015) Primary retroperitoneal masses: what is the differential diagnosis? Abdom Imaging 40 (6):1887-1903. https://doi.org/10.1007/s00261-014-0311-xCrossRefPubMed

Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush WH, Jr., Kolokythas O (2011) Imaging of uncommon retroperitoneal masses. Radiographics 31 (4):949-976. https://doi.org/10.1148/rg.314095132CrossRefPubMed

Nishino M, Hayakawa K, Minami M, Yamamoto A, Ueda H, Takasu K (2003) Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues. Radiographics 23 (1):45-57. https://doi.org/10.1148/rg.231025037CrossRefPubMed

Shaaban AM, Rezvani M, Tubay M, Elsayes KM, Woodward PJ, Menias CO (2016) Fat-containing Retroperitoneal Lesions: Imaging Characteristics, Localization, and Differential Diagnosis. Radiographics 36 (3):710-734. https://doi.org/10.1148/rg.2016150149CrossRefPubMed

Craig WD, Fanburg-Smith JC, Henry LR, Guerrero R, Barton JH (2009) Fat-containing lesions of the retroperitoneum: radiologic-pathologic correlation. Radiographics 29 (1):261-290. https://doi.org/10.1148/rg.291085203CrossRefPubMed

Jagannathan JP, Tirumani SH, Ramaiya NH (2016) Imaging in Soft Tissue Sarcomas: Current Updates. Surg Oncol Clin N Am 25 (4):645-675. https://doi.org/10.1016/j.soc.2016.05.002CrossRefPubMed

10.

Elnemr A, Yonemura Y, Shinbo M, Nishino E (2010) Primary retroperitoneal mullerian adenocarcinoma. Rare Tumors 2 (1):e6. https://doi.org/10.4081/rt.2010.e6CrossRefPubMed

11.

Weiss SW (1996) Lipomatous tumors. Monogr Pathol 38:207-239PubMed

12.

Fiore M, Grosso F, Lo Vullo S, Pennacchioli E, Stacchiotti S, Ferrari A, Collini P, Lozza L, Mariani L, Casali PG, Gronchi A (2007) Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer 109 (12):2522-2531. https://doi.org/10.1002/cncr.22720CrossRefPubMed

13.

Hekimoglu K (2013) Giant retroperitoneal liposarcomas: diagnostic approach with multidetector computed tomography and magnetic resonance imaging. Jbr-Btr 96 (6):375-377. https://doi.org/10.5334/jbr-btr.466CrossRefPubMed

14.

Ghadimi MP, Al-Zaid T, Madewell J, Peng T, Colombo C, Hoffman A, Creighton CJ, Zhang Y, Zhang A, Lazar AJ, Pollock RE, Lev D (2011) Diagnosis, management, and outcome of patients with dedifferentiated liposarcoma systemic metastasis. Ann Surg Oncol 18 (13):3762-3770. https://doi.org/10.1245/s10434-011-1794-0CrossRefPubMed

15.

Baheti AD, O’Malley RB, Kim S, Keraliya AR, Tirumani SH, Ramaiya NH, Wang CL (2016) Soft-Tissue Sarcomas: An Update for Radiologists Based on the Revised 2013 World Health Organization Classification. AJR Am J Roentgenol 206 (5):924-932. https://doi.org/10.2214/AJR.15.15498CrossRefPubMed

16.

Levy AD, Manning MA, Al-Refaie WB, Miettinen MM (2017) Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1-Common Sarcomas: From the Radiologic Pathology Archives. Radiographics 37 (2):462-483. https://doi.org/10.1148/rg.2017160157CrossRefPubMedPubMedCentral

17.

Lahat G, Madewell JE, Anaya DA, Qiao W, Tuvin D, Benjamin RS, Lev DC, Pollock RE (2009) Computed tomography scan-driven selection of treatment for retroperitoneal liposarcoma histologic subtypes. Cancer 115 (5):1081-1090. https://doi.org/10.1002/cncr.24045CrossRefPubMed

18.

Kim EY, Kim SJ, Choi D, Lee SJ, Kim SH, Lim HK, Song SY (2008) Recurrence of retroperitoneal liposarcoma: imaging findings and growth rates at follow-up CT. AJR Am J Roentgenol 191 (6):1841-1846. https://doi.org/10.2214/AJR.07.3746CrossRefPubMed

19.

Kim T, Murakami T, Oi H, Tsuda K, Matsushita M, Tomoda K, Fukuda H, Nakamura H (1996) CT and MR imaging of abdominal liposarcoma. AJR Am J Roentgenol 166 (4):829-833. https://doi.org/10.2214/ajr.166.4.8610559CrossRefPubMed

20.

Hong SH, Kim KA, Woo OH, Park CM, Kim CH, Kim MJ, Chung JJ, Han JK, Rha SE (2010) Dedifferentiated liposarcoma of retroperitoneum: spectrum of imaging findings in 15 patients. Clin Imaging 34 (3):203-210. https://doi.org/10.1016/j.clinimag.2009.12.025CrossRefPubMed

21.

Cooley CL, Jagannathan JP, Kurra V, Tirumani SH, Saboo SS, Ramaiya NH, Shinagare AB (2014) Imaging features and metastatic pattern of non-IVC retroperitoneal leiomyosarcomas: are they different from IVC leiomyosarcomas? J Comput Assist Tomogr 38 (5):687-692. https://doi.org/10.1097/RCT.0000000000000097CrossRefPubMed

22.

Abraham JA, Weaver MJ, Hornick JL, Zurakowski D, Ready JE (2012) Outcomes and prognostic factors for a consecutive case series of 115 patients with somatic leiomyosarcoma. J Bone Joint Surg Am 94 (8):736-744. https://doi.org/10.2106/JBJS.K.00460CrossRefPubMed

23.

Ganeshalingam S, Rajeswaran G, Jones RL, Thway K, Moskovic E (2011) Leiomyosarcomas of the inferior vena cava: diagnostic features on cross-sectional imaging. Clin Radiol 66 (1):50-56. https://doi.org/10.1016/j.crad.2010.08.004

24.

O’Sullivan PJ, Harris AC, Munk PL (2008) Radiological imaging features of non-uterine leiomyosarcoma. Br J Radiol 81 (961):73-81. https://doi.org/10.1259/bjr/18595145CrossRefPubMed

25.

Yakupoglu A, Ulus S, Cantasdemir M (2016) Leiomyosarcoma of the Inferior Vena Cava Confirmed by Aspiration Biopsy With a Catheter During Digital Subtraction Angiography. Vasc Endovascular Surg 50 (3):164-167. https://doi.org/10.1177/1538574416637445

26.

Huang J, Liu Q, Lu JP, Wang F, Wang L, Jin AG (2011) Primary intraluminal leiomyosarcoma of the inferior vena cava: value of MRI with contrast-enhanced MR venography in diagnosis and treatment. Abdom Imaging 36 (3):337-341. https://doi.org/10.1007/s00261-010-9656-y

27.

Brennan MF, Antonescu CR, Alektiar KM, Maki RG (2016) Undifferentiated Pleomorphic Sarcoma (UPS) (Malignant Fibrous Histiocytoma (MFH) and Myxofibrosarcoma). In: Management of Soft Tissue Sarcoma. Springer International Publishing, Cham, pp 143-152. https://doi.org/10.1007/978-3-319-41906-0_7

28.

Cong Z, Gong J (2011) Primary malignant fibrous histiocytoma of the liver: CT findings in five histopathological proven patients. Abdom Imaging 36 (5):552-556. https://doi.org/10.1007/s00261-011-9691-3CrossRefPubMed

29.

Osman S, Lehnert BE, Elojeimy S, Cruite I, Mannelli L, Bhargava P, Moshiri M (2013) A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol 42 (5):191-208. https://doi.org/10.1067/j.cpradiol.2013.02.001

30.

Kim KH, Lee SH, Cha SH, Kim YS, Sung DJ (2012) Malignant fibrous histiocytoma arising from a hydronephrotic kidney: a case report and review of the literature. Clin Imaging 36 (3):239-242. https://doi.org/10.1016/j.clinimag.2011.09.001CrossRefPubMed

31.

Lee SY, Jee WH, Jung JY, Park MY, Kim SK, Jung CK, Chung YG (2016) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 26 (3):743-754. https://doi.org/10.1007/s00330-015-3878-x

32.

Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, Elsayes KM (2017) Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 90 (1075):20170039. https://doi.org/10.1259/bjr.20170039CrossRefPubMedPubMedCentral

33.

Sung CK, Kim B, Moon KC, Ku JH, Ha SB (2017) Retroperitoneal Tumors. In: Kim SH, Cho JY (eds) Oncologic Imaging: Urology. Springer Berlin Heidelberg, Berlin, Heidelberg, pp 227-260. https://doi.org/10.1007/978-3-662-45218-9_6

34.

Miao C, Luo C-H (2018) Retroperitoneal Rhabdomyosarcoma. In: Luo C-H (ed) Retroperitoneal Tumors. Springer Netherlands, Dordrecht, pp 183-184. https://doi.org/10.1007/978-94-024-1167-6_17

35.

Miao C, Luo C-H (2018) Retroperitoneal Synovial Sarcoma. In: Luo C-H (ed) Retroperitoneal Tumors. Springer Netherlands, Dordrecht, pp 259-261. https://doi.org/10.1007/978-94-024-1167-6_33

36.

Thway K, Fisher C (2015) PEComa: morphology and genetics of a complex tumor family. Ann Diagn Pathol 19 (5):359-368. https://doi.org/10.1016/j.anndiagpath.2015.06.003CrossRefPubMed

37.

Crino PB, Nathanson KL, Henske EP (2006) The tuberous sclerosis complex. N Engl J Med 355 (13):1345-1356. https://doi.org/10.1056/NEJMra055323CrossRefPubMed

38.

Phillips CH, Keraliya AR, Shinagare AB, Ramaiya NH, Tirumani SH (2016) Update on the imaging of malignant perivascular epithelioid cell tumors (PEComas). Abdom Radiol (NY) 41 (2):368-376. https://doi.org/10.1007/s00261-015-0568-8CrossRef

39.

Liang W, Xu C, Chen F (2015) Primary retroperitoneal perivascular epithelioid cell neoplasm: A case report. Oncol Lett 10 (1):469-472. https://doi.org/10.3892/ol.2015.3210CrossRefPubMedPubMedCentral

40.

Hedgire SS, Kudrimoti S, Oliveira IS, Nadkarni N, McDermott S, Hahn PF, Mino-Kenudson M, Harisinghani MG (2017) Extranodal lymphomas of abdomen and pelvis: imaging findings and differential diagnosis. Abdom Radiol (NY) 42 (4):1096-1112. https://doi.org/10.1007/s00261-016-0964-8CrossRef

41.

Rosenkrantz AB, Spieler B, Seuss CR, Stifelman MD, Kim S (2012) Utility of MRI features for differentiation of retroperitoneal fibrosis and lymphoma. AJR Am J Roentgenol 199 (1):118-126. https://doi.org/10.2214/AJR.11.7822CrossRefPubMed

42.

Neville A, Herts BR (2004) CT characteristics of primary retroperitoneal neoplasms. Crit Rev Comput Tomogr 45 (4):247-270CrossRef

43.

Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM (2003) Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics 23 (1):29-43. https://doi.org/10.1148/rg.231025050CrossRefPubMed

44.

MJ, Thomas JM, Fisher C, Moskovic EC (2005) Imaging features of retroperitoneal and pelvic schwannomas. Clin Radiol 60 (8):886-893. https://doi.org/10.1016/j.crad.2005.01.016CrossRefPubMed

45.

Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF, Jr. (2001) Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab 86 (11):5210-5216. https://doi.org/10.1210/jcem.86.11.8034CrossRefPubMed

46.

Lonergan GJ, Schwab CM, Suarez ES, Carlson CL (2002) Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics 22 (4):911-934. https://doi.org/10.1148/radiographics.22.4.g02jl15911CrossRefPubMed

47.

Choyke PL, Hayes WS, Sesterhenn IA (1993) Primary extragonadal germ cell tumors of the retroperitoneum: differentiation of primary and secondary tumors. Radiographics 13 (6):1365-1375; quiz 1377-1368. https://doi.org/10.1148/radiographics.13.6.8290730

48.

Keitoku M, Konishi I, Nanbu K, Yamamoto S, Mandai M, Kataoka N, Oishi T, Mori T (1997) Extraovarian sex cord-stromal tumor: case report and review of the literature. Int J Gynecol Pathol 16 (2):180-185. https://doi.org/10.1097/00004347-199704000-00017CrossRefPubMed

49.

Trabelsi A, Ben Abdelkarim S, Hadfi M, Fatnaci R, Stita W, Sriha B, Korbi S (2008) Primary mesenteric Sertoli–Leydig cell tumor: a case report and review of the literature. J Oncol 2008:619637. https://doi.org/10.1155/2008/619637CrossRefPubMedPubMedCentral

50.

Ueno T, Tanaka YO, Nagata M, Tsunoda H, Anno I, Ishikawa S, Kawai K, Itai Y (2004) Spectrum of germ cell tumors: from head to toe. Radiographics 24 (2):387-404. https://doi.org/10.1148/rg.242035082CrossRefPubMed

51.

Gatcombe HG, Assikis V, Kooby D, Johnstone PA (2004) Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol 86 (2):107-113. https://doi.org/10.1002/jso.20043CrossRefPubMed

52.

Davidson AJ, Hartman DS, Goldman SM (1989) Mature teratoma of the retroperitoneum: radiologic, pathologic, and clinical correlation. Radiology 172 (2):421-425. https://doi.org/10.1148/radiology.172.2.2664866CrossRefPubMed

53.

Mathur P, Lopez-Viego MA, Howell M (2010) Giant primary retroperitoneal teratoma in an adult: a case report. Case Rep Med 2010. https://doi.org/10.1155/2010/650424CrossRefPubMedPubMedCentral

54.

Surabhi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple NC (2008) Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. Radiographics 28 (4):1005-1017. https://doi.org/10.1148/rg.28407515CrossRefPubMed

55.

Mesurolle B, Sayag E, Meingan P, Lasser P, Duvillard P, Vanel D (1996) Retroperitoneal extramedullary hematopoiesis: sonographic, CT, and MR imaging appearance. AJR Am J Roentgenol 167 (5):1139-1140. https://doi.org/10.2214/ajr.167.5.8911166CrossRefPubMed

56.

Georgiades CS, Neyman EG, Francis IR, Sneider MB, Fishman EK (2002) Typical and atypical presentations of extramedullary hemopoiesis. AJR Am J Roentgenol 179 (5):1239-1243. https://doi.org/10.2214/ajr.179.5.1791239CrossRefPubMed

57.

Orphanidou-Vlachou E, Tziakouri-Shiakalli C, Georgiades CS (2014) Extramedullary hemopoiesis. Semin Ultrasound CT MR 35 (3):255-262. https://doi.org/10.1053/j.sult.2013.12.001CrossRefPubMed

58.

Zhou LP, Zhang B, Peng WJ, Yang WT, Guan YB, Zhou KR (2008) Imaging findings of Castleman disease of the abdomen and pelvis. Abdom Imaging 33 (4):482-488. https://doi.org/10.1007/s00261-007-9282-5CrossRefPubMed

59.

Cohn JE, Zhou J, Hu A (2018) Castleman disease. Ear Nose Throat J 97 (8):233-234. https://doi.org/10.1177/014556131809700819CrossRefPubMed

60.

Meador TL, McLarney JK (2000) CT features of Castleman disease of the abdomen and pelvis. AJR Am J Roentgenol 175 (1):115-118. https://doi.org/10.2214/ajr.175.1.1750115CrossRefPubMed

61.

Irsutti M, Paul JL, Selves J, Railhac JJ (1999) Castleman disease: CT and MR imaging features of a retroperitoneal location in association with paraneoplastic pemphigus. Eur Radiol 9 (6):1219-1221. https://doi.org/10.1007/s003300050821CrossRefPubMed

62.

Czeyda-Pommersheim F, Hwang M, Chen SS, Strollo D, Fuhrman C, Bhalla S (2015) Amyloidosis: Modern Cross-sectional Imaging. Radiographics 35 (5):1381-1392. https://doi.org/10.1148/rg.2015140179CrossRefPubMed

63.

Kawashima A, Alleman WG, Takahashi N, Kim B, King BF, Jr., LeRoy AJ (2011) Imaging evaluation of amyloidosis of the urinary tract and retroperitoneum. Radiographics 31 (6):1569-1582. https://doi.org/10.1148/rg.316115519CrossRefPubMed

Title: Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know
Authors: Ferenc Czeyda-Pommersheim
Christine Menias
Annemarie Boustani
Margarita Revzin
Publication date: 01-03-2021
Publisher: Springer US
Keywords: Liposarcoma
Retroperitoneal Fibrosis
Retroperitoneal Fibrosis
Pathology
Amyloidosis
Arteriovenous Malformation
Published in: Abdominal Radiology / Issue 3/2021
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-020-02752-8

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