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Wen J, Zhao Y, Tang F, Cheng W, Peng J, Li Q, Pan H, Li H, Chen L. Full-term pregnancy with retroperitoneal giant mucinous cyst: A case report and literature review. Medicine (Baltimore) 2024; 103:e36979. [PMID: 38457602 PMCID: PMC10919471 DOI: 10.1097/md.0000000000036979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/22/2023] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Retroperitoneal benign cysts during pregnancy are extremely rare and often remain asymptomatic until they attain a very large size. Diagnosis typically relies on a pathological tissue biopsy. The decision to pursue 1-step or 2-step surgical treatment should be tailored to each individual case rather than generalized. PATIENT CONCERNS This case report presents the unique scenario of a pregnant woman with a confirmed pregnancy complicated by a large retroperitoneal cyst. The patient had a retroperitoneal cyst during her initial pregnancy, which went undetected during the first cesarean section. However, it was identified during her second pregnancy by which time it had grown to 13.0 cm × 15.0 cm × 25.0 cm, and extended from the liver margin to right ovarian pelvic infundibulopelvic ligament. Consequently, it was removed smoothly during her second cesarean section. DIAGNOSES Postoperative pathology results indicated a massive retroperitoneal mucinous cystadenoma. INTERVENTIONS The giant retroperitoneal cyst was smoothly excised during the second cesarean delivery for 1-step surgical treatment. OUTCOMES Under the combined spinal and epidural anesthesia, a live female infant was delivered at 38 3/7 gestational weeks and the neonatal weight was 3200g. Under general anesthesia with endotracheal intubation, the giant retroperitoneal cyst was excised smoothly without complications. LESSONS The findings of this case report contribute to the understanding of the diagnostic modalities, surgical approaches and postoperative considerations of giant retroperitoneal cysts associated with pregnancy.
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Affiliation(s)
- Jiao Wen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wuhan University of Science and Technology, Wuhan, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxing Cheng
- Wuhan University of Science and Technology, Wuhan, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianyi Li
- Wuhan University of Science and Technology, Wuhan, China
| | | | - Hao Li
- Huazhong University of Science and Technology, Wuhan, China
| | - Lei Chen
- Huazhong University of Science and Technology, Wuhan, China
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Shah D, Chaudhary SR, Khan S, Mallik S. Overreliance on Radiological Findings Leading to Misdiagnosed Giant Retroperitoneal Ganglioneuroma: A Case Report and Literature Review. Cureus 2023; 15:e43914. [PMID: 37746449 PMCID: PMC10512760 DOI: 10.7759/cureus.43914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are even less common; this is only the 19th reported case in literature to date. We present a case of a giant retroperitoneal ganglioneuroma in a five-year-old child, which on imaging mimicked a mesenteric cyst and posed various challenges in its management. Histopathology later confirmed our misdiagnosis and revealed the tumor to be a ganglioneuroma. This unique case serves as a lesson for clinicians to not operate before receiving histopathological confirmation of their diagnosis.
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Affiliation(s)
| | | | - Shahin Khan
- General Surgery, Medical College Baroda, Vadodara, IND
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Xiao J, Zhao Z, Li B, Zhang T. Primary Retroperitoneal Ganglioneuroma: A Retrospective Cohort Study of 32 Patients. Front Surg 2021; 8:642451. [PMID: 34095202 PMCID: PMC8176303 DOI: 10.3389/fsurg.2021.642451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To investigate the clinical characteristics, diagnosis, differential diagnosis, therapy options, and outcomes of retroperitoneal ganglioneuroma. Methods: In this retrospective study, we collected and analyzed the clinical data of 32 patients diagnosed with retroperitoneal ganglioneuroma and admitted to Peking Union Medical College Hospital from October 2012 to August 2019. Results: Among our 32 cases with retroperitoneal ganglioneuroma, the male-to-female ratio was 1:3 and the mean age was 35. Only 25% of the cases presented with abdominal pain while more than 65% had no specific symptoms. The masses could be found through physical examination in only five patients. Most of the tumors are located near the renal area. They were usually single and displayed an embedded growth pattern with diameters <10 cm, clear borders, and soft texture. For radiological imaging, the majority of tumors demonstrated soft tissue density with mild-to-moderate enhancement on CT imaging and showed hypoecho with moderate blood flow signals in ultrasound. No significantly abnormal laboratory examinations were found in most patients. Of all the 32 patients, 2 chose surveillance after biopsy due to difficulties in operation, while others chose surgical resection. The mean follow-up time was 15.8 months among 26 patients. The tumor remained stable in the surveillance cases. Residual tumors were found in four cases receiving operations with no progress and discomfort. No recurrence was seen in all patients. Conclusions: The retroperitoneal ganglioneuroma is a benign tumor without specific clinical manifestations or significant laboratory findings. Typically, it is shown as low density with a clear border and an embedded growth pattern in radiological imaging. The overall prognosis is good. Surgery is an effective approach with possible severe complications. Incomplete resection or surveillance can be considered for some cases where complete resection is difficult to achieve.
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Affiliation(s)
- Jianchun Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixuan Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Lawrie K, Whitley A, Rokošný S, Bafrnec J, Gürlich R, Baláž P. Oncovascular Resection of a Ganglioneuroma Involving the Coeliac Trunk and Hepatic Artery-A Case Report. Vasc Endovascular Surg 2021; 55:519-523. [PMID: 33583359 DOI: 10.1177/1538574421994414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A large tumorous mass completely surrounding and compressing the coeliac trunk was identified on computed tomography in a young woman with a six-month history of progressive abdominal pain. The tumor was excised along with the coeliac trunk and the proximal parts of its branches. The hepatic artery was reconstructed with an aorto-hepatic autogenous bypass. Postoperatively the patient had neurogenic diarrhea, which subsided on medical treatment. Seven months after surgery the patient is in a good state of health and living a normal life.
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Affiliation(s)
- Kateřina Lawrie
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Slavomír Rokošný
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Bafrnec
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Robert Gürlich
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Baláž
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovakia
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Taffurelli G, Ricci C, Casadei R, Selva S, Minni F. Open adrenalectomy in the era of laparoscopic surgery: a review. Updates Surg 2017; 69:135-143. [DOI: 10.1007/s13304-017-0440-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/01/2017] [Indexed: 12/27/2022]
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Organ Preservation in a Case of Retroperitoneal Ganglioneuroma: A Case Report and Review of Literature. Case Rep Surg 2016; 2016:6597374. [PMID: 27668117 PMCID: PMC5030439 DOI: 10.1155/2016/6597374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/17/2016] [Indexed: 12/02/2022] Open
Abstract
The retroperitoneum is a closed space harbouring vital organs including the great vessels, kidneys and adrenal glands, ureters, and the ascending and descending colon. Surgical management of retroperitoneal pathologies may need multiorgan resection in order to achieve complete surgical resection while preservation of surrounding organs should be attempted, especially in case of benign tumors. We present a case of 15-year-old girl with an 11 × 6 × 5 cm retroperitoneal ganglioneuroma displacing the right kidney, renal vein, and ureter and abutting the IVC which was excised in toto preserving the right kidney and ureter with careful dissection around the great vessels. We also attempt to review the various surgical options available while dealing with these benign retroperitoneal tumors which are often detected incidentally and usually surround important retroperitoneal organs and vessels.
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Hussain A, Bhakta P, Singh V. Anesthetic management of cesarean section in a patient complicated with neuroectodermal tumor: a case report. J Clin Anesth 2015; 27:532-3. [PMID: 26164308 DOI: 10.1016/j.jclinane.2015.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ashfaq Hussain
- Department of Anesthesia and Intensive Care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | - Pradipta Bhakta
- Department of Anesthesia and Intensive Care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | - Vikash Singh
- Department of Anesthesia and Intensive Care, Beaumont Hospital, Dublin, Ireland.
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Incidentally detected ganglioneuroma during pregnancy: A case report. Obstet Gynecol Sci 2014; 57:228-31. [PMID: 24883295 PMCID: PMC4038690 DOI: 10.5468/ogs.2014.57.3.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/04/2013] [Accepted: 10/11/2013] [Indexed: 11/08/2022] Open
Abstract
Retroperitoneal ganglioneuroma is a rare benign tumor, which is included in the neuroblastomas group. It can occur anywhere along the peripheral autonomic ganglion sites, and the tumor is often incidentally detected in asymptomatic patients or may produce symptoms related to the slow growing tumor. Surgical excision is the treatment of choice and the prognosis is good. We report a case of retroperitoneal ganglioneuroma, which was incidentally detected in the first trimester of pregnancy in a 29-year-old woman. Surgical resection of the ganglioneuroma was done at the time of cesarean section at full term without complications.
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Meng ZH, Yang YS, Cheng KL, Chen GQ, Wang LP, Li W. A huge malignant peripheral nerve sheath tumor with hepatic metastasis arising from retroperitoneal ganglioneuroma. Oncol Lett 2012; 5:123-126. [PMID: 23255906 DOI: 10.3892/ol.2012.961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/05/2012] [Indexed: 11/06/2022] Open
Abstract
Ganglioneuromas (GNs) are the rarest and most benign of the neuroblastic tumors. We experienced a case of huge retroperitoneal GN which differentiated into malignant peripheral nerve sheath tumors (MPNST) with hepatic metastasis. The tumor was located in the upper right quarter of the abdomen and pressed the right lobe of the liver, which was initially misdiagnosed as a liver carcinoma. The tumor shared blood supply with the right liver lob and had rich blood supplies from the abdominal aorta, renal artery and hepatic artery. It was also associated with skin pigment and recurrence shortly following resection. Our finding demonstrated that MPNST is a potent invasive malignant tumor and metastasis earlier with very poor prognosis.
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Affiliation(s)
- Z H Meng
- Departments of Hepatobiliary-Pancreatic Surgery
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