The document discusses retroperitoneal masses. It notes that primary retroperitoneal masses originate in the retroperitoneum outside major organs. CT and MRI are important imaging modalities. Retroperitoneal masses can be solid or cystic neoplastic or non-neoplastic tumors. The majority are malignant. Common solid neoplastic masses include mesodermal tumors like liposarcomas, neurogenic tumors, and germ cell tumors. Imaging findings of common tumor types are described.
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Rhabdomyosarcoma is a malignant mesenchymal tumor with features of skeletal muscle. It is the most common childhood and adolescent soft tissue sarcoma, frequently involving the head and neck in children.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
3. • Primary retroperitoneal masses, which originate in
the retroperitoneum but outside the major
retroperitoneal organs, are uncommon.
• Divided primarily into solid and cystic masses, each
of which can be further subdivided into neoplastic
and non neoplastic masses.
• 70-80 % are malignant
• 0.1%-0.2% of all malignancies in the body.
4. Computed tomography (CT) and magnetic resonance (MR) imaging
Although CT is best for assessing calcification, MR imaging
has superior soft-tissue contrast, which is useful for staging and the
Ultrasonography (US) plays a relatively limited role in the evaluation
6. The following are among the common signs:
a) The beak sign (positive when the mass causes the
edge of an adjacent organ to become beak shaped, meaning that th
b)The phantom organ sign (positive when a huge mass arises from
c) The embedded organ sign (positive when part of a hollow organ
d) The prominent feeding artery sign (particularly useful for hyperv
7. Specific diagnoses can be suggested with CT when the following ar
a) Calcifications (ganglioneuroma; malignant fibrohis
tiocytoma)
b) Adipose tissue (homogeneous: lipoma ; heterogeneous: liposarco
c) Necrotic areas (tumors with high grade malignancy
such as leiomyosarcoma
d) Hypervascularization (hemangioma, hemangioperi-
cytoma)
e) Areas of low homogeneous density (neurofibroma)
8. Signs that are specifically appreciable with MRI :
a) Target sign: central area with a low or intermediate
signal surrounded by a hyperintense ring in T2. Histologically it corre
b) Bowl of fruit sign: low intensity mosaic, intermediate and high sig
9. c) Whorled appearance: a linear or curvilinear structure appearing
d) Flow void: this is often seen in hemangiopericytoma, arterioveno
e) Speckled enhancement: this can be found in T1WI after CM and
10. • The retroperitoneum extends from the
diaphragm superiorly to the pelvis inferiorly
and is situated between the posterior parietal
peritoneum anteriorly and the tranversalis
fascia posteriorly.
• The retroperitneum is broadly divided into
the anterior and posterior pararenal
,perirenal and great vessel spaces.
15. Solid Neoplastic Masses
• Broadly divided into four groups:
a) Mesodermal neoplasms
b) Neurogenic tumors
c) Germ cell , sex cord and stromal tumors
d) Lymphoid and hematologic neoplasm
16. Mesodermal neoplasms
• Most of the retroperitneal neplasm are of mesodermal origin , with
liposarcomas ,leiomyosarcomas and malignant fibrous
histiocytomas making up more than 80 % of these tumors.
• Commonly seen in the 5th and 6th decades of life.
• They are large at the time of clinical presentation and often involve
adjacent structures
• Compression of adjacent organs causes formation of
pseudocapsules
• The recurrent rate is high.
• Metastases to liver,lung,bones and brain.
17. Liposarcoma
• Liposarcoma is the most common ( 33 % ) primary
retroperitoneal sarcoma.
• Liposarcoma is usually large ( average diameter >
20 cm ) ,slow growing tumor.
• It is predominantly hypo attenuating lesion on CT
because of its fat content.
• On MRI ,fat signal intensity is followed.
18. • The appearence of
liposarcoma maybe
similar to that of a
lipoma, but liposarcoma
has thicker ,irregular and
nodular septa that shows
enhancement after
contrast material
administration.
19. • Occasionally , a portion of the well - differentiated liposarcoma
undergoes histological dedifferentiation and becomes more
aggressive and metastatic eventually carries a worse prognosis
• CT & MRI imaging ,the dedifferentiated tumors are depicted as
heterogenous tumours with both fat and solid components and
shows lack of clear delineation between solid and fat components
• Calcification is seen in 30 % cases and is an important sign of
dedifferentiation.
• Variable signal intensity and enhancement of the solid portion
maybe seen.
20. Leiomyosarcoma
• Leiomyosarcoma is the second most common ( 28 % )
primary retroperitoneal sarcoma.
• It arises from retroperitoneal smooth muscle tissue ,
blood vessels or wolffian duct remnants.
• It can grow to a large mass ( > 10 cm ) before
compromising adjacent organs and precipitating clinical
symptoms such as venous thrombosis.
• Most common in women in the 5th to 6th decades.
• Predominantly extravascular ( 62 % ) or intravascular ( 5%
) also it can be a combination of extra and intravascular
components ( 33 % )
21. • On CT scan ,small
tumors can be
homogenously solid,
but large tumors
have extensive areas
of necrosis and
occasional
hemorrhage.
22. • MRI shows intermediate to low signal intensity on
T1WI and intermediate signal intensity on T2WI
,depending on the amount of necrosis.
• Mixed signal intensity and fluid debris level can be
seen in hemorrhagic lesions.
• The presence of extensive necrosis in a
reteroperitoneal mass, with contagious
involvement of vessel is highly suggestive of
leimoyosarcoma.
• Metastasis to the liver,lungs or lymphnodes occurs
late in the course of the disease.
23. • Approximately 6% of
leiomyosarcoma arise
from the IVC
• Most of these tumors
have a large
extravascular component
that makes it difficult to
distinguish from a
secondary involvement
of the IVC .
24. • The most commonly effected location is the segment
between the diaphragm and renal veins.
• Tumor involving the superior segment of the IVC (
above the hepatic vein ) may manifest with Budd-Chiari
syndrome.
• The middle segment (between the hepatic and renal
veins) manifest with right upper quadrant pain
,tenderness or with nephrotic syndrome.
• The inferior segment ( below the renal veins ) manifest
with pain and lower extremity oedema.
25. • MRI typically shows an intraluminal intermediate signal
intensity mass on T1WI and T2WI , with contrast
enhancement.
• The differential diagnosis includes benign thrombus
,angiosarcoma and a tumor extending into the IVC from
adjacent organs.
• While benign bland thrombus does not show contrast
enhancement,lieomyosarcoma of the IVC enhances on both early
and delayed ( 10 min ) contrast enhanced images and causes more
expansion of the IVC.
• Tumors from the middle segment of the IVC has a
better prognosis than those from other IVC segment.
26. Malignant Fibrous Histiocytoma
• It is the third most common retroperitoneal sarcoma (
19 %) and over all is the most common soft tissue
sarcoma in the body
• It arises from primitive mesenchymal elements and 15 %
of these tumors occur in the retroperitoneum.
• CT and MRI appearances are nonspecific and
demonstrate a large, infiltrating and heterogeneously
enhancing soft tissue mass with areas of necrosis and
haemorrhage and with invasion of adjacent organs.
27. • Variable patterns of
calcification can be
seen ( 7%-20% of
cases ) in the
peripheral of these
tumors
• The presence of
calcification may help
to distinguish
malignant
histiocytoma from
leiomyosarcoma.
28. Less common sarcoma -
Rhabdomyosarcoma
• It has bimodal distribution in the paediatric population,
peaks at 7 years and at adolescence.
• CT / MRI shows a mass lesion with areas of
calcification,necrosis and heterogenous enhancement.
• Occasionally , high flow
blood vessels maybe seen.
• Metastasis occurs in 10-20
% of cases because of
lymphatics or
hematogeneous spread.
29. Angiosarcoma
Angiosarcoma is a malignant tumor of endothelial and mesenchym
CT or MR imaging shows an enhancing mass expanding the involve
MR imaging may show high signal intensity on
T2WI , that is due to tumor necrosis and the presence of methemo
30.
31. Angiomyolipoma
• It has varying amounts of blood vessels,smooth muscle cells
and adipose tissues.
• Commonly seen in females and associated with tuberous
sclerosis.
• Occurs in younger age group ( 25-35 years)
• Common loction is kidneys but occasionally seen in
retroperitoneum ,solid organs or skin.
• CT/MRI of angiomyolipoma ,small tumors are homogenbous
and large tumors area heterogenous soft tissue mass that
typically contain a large amount of macroscopic fat and
heterogenous enhancing vascular soft tissue.
32. • Enlarged vessels coursing through the lesion
,aneurysm and associated hemorrhage area
features that enable to distinguish
angiomyolipoma from liposarcoma
• Insert picture
33.
34.
35. Desmoid tumors
• Fibromatosis is a group of conditions that arise from musculoaponeurotic structures an
• Fibromatosis can be either superficial or deep.
• Desmoid tumor (deep fibromatosis, aggressive fibromatosis, well-differentiated fibrosa
• Desmoid tumor can be sporadic or associated with familial polyposis coli and Gardner s
• It is hormonally responsive and dependent on estrogen.
• This tumor is more common in females,from puberty to 40 years, with a peak in occurr
• Histologically, desmoid tumor is composed of well-differentiated
elongated uniform spindle cells, which are separated by collagen.
36. The imaging appearance of a desmoid tumor depends on the tissue composition (sp
At MR imaging, early-stage lesions are cellular and have high signal intensity on
T2-weighted images; but with loss of cellularity and deposition of collagen, the lesio
Hypo intense tracks may also be seen that are due to dense collagen bands.
Moderate to marked contrast enhancement is demonstrated on contrast enhanced
Deep desmoid tumor grows rapidly, is more aggressive, and is prone to recur (50%),
37.
38. Neurogenic tumors
• Neurogenic tumours constitute of 10-20 % of
primary retroperitoneum tumours.
• Compared with the mesenchymal
tumors,neurogenic tumors occur in younger
age group ,more likely to be benign and better
prognosis
40. Neurogenic tumors are commonly seen:
• Along the smpathetic ganglia,which are
located in the paraspinal region.
• In the adrenal medulla or the organs of
zuckerkandl (paraortic bodies ).
41. schwannoma
• Schwannoma or neurilemoma , is a benign tumour
that arises from the perineural sheath of Schwann (
neurilemma)
• It accounts for 6% of retroperitoneal neoplasm and
more common than neurofibroma.
• Asymptomatic.
• Females ( 2:1 )
• 20-50 year age group
42. • On CT ,small schwannomas are
round, well defined and
homogenous. If large ,shows
heterogenous in appearance.
• Calcifications can be
mottled,punctate or curvilinear
• The nerve of origin is often
difficult to identify.
• On post contrast study the
schwannomas show variable
homogenous or heterogenous
enhancement.
43. Neurofibroma
• Benign nerve sheath tumor that can occur as an
isolated ( 90%) or as part of type I
neurofibromatosis.
• Approximately 30% of solitary tumors and 100 % of
multiple tumors or plexiform neurofibromas are
associated with type I neurofibromatosis.
• Common in men of age 20- 40 years.
44. • On CT neurofibroma is
depicted as a well
defined round
homogeneously hypo
attenuating lesion ( 20-
25 HU ) because of the
presence of lipid –rich
Schwann cells and
adipocytes and
entrapment of adjacent
fat. On post contrast
study ,it shows
homogenous
enhancement.
45. • Tumors involving the
neural foramen have a
dumbells shape with
expansion of the
foramina or vertebral
body scalloping
• Plexiform neurofibroma
is seen as a large
extensive infiltrating
mass.
46. Malignant nerve sheath tumor
• Malignant nerve sheath tumor include malignant schwannoma
,neurogenic sarcoma and neurofibrosarcoma.
• Progressive enlargement , pain , irregular margins, heterogenous
nature and infiltration into adjacent soft tissues are suggestive of
malignancy especially when associated with type I
neurofibromatosis.
47. Ganglioneuroma
• Rare benign tumor that arises from the sympathetic ganglia
• The retroperitoneum ( 32%-52% of cases) and mediastinum (
39% -43% of cases) are the most common sites for
ganglioneuroma, followed by the cervical region ( 8%-9% of
cases )
• CT shows circumscribed lobulated hypoattenuating mass
that may surround a blood vessel without narrowing the
lumen.
• Discrete punctuate calcifications are seen in 20%-30%.
48. Ganglioneuroblastoma and neuroblastoma
• Ganglioneuroblastoma is an intermediate
grade tumor that has elements of benign
ganglioneuroma and malignant neuroblastoma
• It is a pediatric tumor occurring in 2-4 year age
group
• Imaging appearances vary,it can be solid or
cystic with solid components.
49. • Neuroblastoma is malignant and is more commonly seen in
males and in the 1st decade of life.
• 2/3rd of neuroblastomas are located in the adrenal gland
and the remaining neuroblastoma occur along the
paravertebral sympathetic chain.
• On CT / MRI imaging,neuroblastoma is irregular ,lobulated
and heterogenous and shows coarse amorphous
calcifications with variable contrast enhancement.
• It also shows invasion of adjacent organs and
enhancement of vessels with luminal compression.
• As many as 70% of patients have metastatic disease at the
time of diagnosis.
50. Paraganglioma
( Extraadrenal pheochromocytoma)
• Tumors that arise from the chromaffin cells of the adrenal
medulla are called pheochromocytomas, and those that arise in
an extraadrenal location ( 10%) are referred to as
paragangliomas.
• Paraganglioma is commonly
seen in the 3rd to 4th
decades with no sex
predilection.
• In the retroperitoneum ,
the most common site for
the paraganglioma is the
organs of
zuckerkandl,which are
located anterior to the
aorta at the level of the
origin of the inferior
mesenteric artery.
51. CT:
• Large well defined lobular tumor with areas of haemorrhage and
necrosis.
• Punctate calcifications is seen in 15% of cases and a fluid-fluid level
can be seen that is due to haemorrhage.
• Because of the hypervascular nature of paraganglioma,intense
contrast enhancement is seen.
MRI:
• Signal voids can be seen with T1W spin echo sequences
• Variable signal intensity is seen on T2WI
• Although paraganglioma maybe “ bright” , the tumor is usually
complex and heterogenous ( because of haemorrhage )
52.
53. Germ cell , sex cord and stromal cell tumors
primary extragonadal germ cell tumors
• Histopathologically these tumors can be seminomas or non seminomatous
germ cell tumors, which include embryonal carcinoma,yolk sac tumor
,choriocarcinoma ,teratoma and mixed germ cell tumors
• The retroperitoneum is the second most common site of extra gonadal
germ cell tumor after the mediastium.
• Extragonadal germ cell tumor is often seen in or near the midline ,
especially between the T6 and S2 vertebrae.
• A midline mass is more suggestive of a primary extragonadal germ cell
tumor than of metastasis.
• On CT and MRI , the findings of primary extragonadal germ cell tumors are
non specific.
54. • Non seminomatous germ cell tumors are depicted as
heterogenous tumors with area of hemorrhage , necrosis
and heterogenous enhancement.
55. Teratoma
• A germ cell tumor that originates from pluripotent
germ cells that have been interrupted in their normal
migration for the genital ridge.
• Less than 10 % of teratomas are found in the
retroperitoneum.
• It is the third most common tumor in the
retroperitoneum in children after neuroblastoma and
wilm’s tumor.
• Commonly seen in females with a bimodal age
distribution ( <6 months and early adulthood )
56. • Mature teratomas are predominantly cystic.
Calcifcations and fat can be seen. A fat-fluid
(sebum) level and chemical shift between fat
and fluid are pathognomic.
Axial CT image of a
21 yr old woman
woman shows a
well defined
heterogenous
mass that
demonstrate fat
and teeth
57. Primary sex cord stromal tumors
• Extraovarian primary sex cord stromal tumor is more
commonly seen in the pelvis along the broad ligament
or fallopian tubes.
• Less commonly seen in the retroperitoneum or
adrenal glands.
• Most of these tumors are granulosa cell tumors.
• The imaging findings are non specific
• CT and MRI show heterogenous solid tumors with
heterogenous enhancement.
58.
59. Lymphoid Neoplasms
Lymphoma:
• Most common retroperitoneal malignancy, accounting for
33% of these cases
• CT: shows a well defined homogenous mass, with mild
homogenous contrast enhancement , that spreads between
normal structures without compression them.
• The aorta and IVC can be displaced anteriorly , producing the
“floating aorta” or” CT angiogram” sign.
• Calcification and necrosis are unusual before therapy.
62. Lipomatosis
• Lipomatosis is a benign metaplastic overgrowth of mature
unencapsulated white fat.
• Commonly seen in the pelvis and along the perirectal and
perivescular spaces.
• Less commonly seen in reteroperitoenum.
• CT& MRI : shows excess fat in the pelvis crowding the
anatomic structures with few fibrous tissue strands without
evidence of soft tissue mass or enhancement.
63. • A pear shaped bladder is produced by symmetric
compression and displacement of the bladder caused
by pelvic lipomatosis
• The lower portion of the ureters maybe pinched
medially, with resultant hydroureteronephrosis.
64. Reteroperitoneal fibrosis
• Uncommon collagen vascular disease of unknown cause
that can mimic retroperitoneal tumor.
• Typically idiopathic ( > 70 % of cases ) and is likely
autoimmune in origin.
• It can be secondary to
drugs,malignancy,hemorrahge,inflammatory conditions
,infection,radiation,chemotherapy,renal trauma and
amyloidosis.
• More common in males ( 3:1).
• Age: 40-60 years age group.
65. • CT : Irregular plaque like soft tissue mass in the
retroperitoneum,located around the aortic bifurcation
and extending along the iliac arteries and involving the
ureters,duodenum,pancreas and spleen/.
• It does not displace the aorta and IVC anteriorly , as
lymphoma or metastatic node often do ,but causes
tethering of these structures to the underlying vertebrae.
66. • Avid enhancement is seen in the active stages of
retroperitoneal fibrosis with little or no
enhancement in the chronic phase.
• MRI : High signal intensity on T2WI in the acute
phase of the disease, with early contrast
enhancement.
• Shows low signal intensity in the chronic
fibrosing phase with delayed enhancement.
67. Erdheim – chester disease
• It is a rare non- langerhans form of histiocytosis of
unknown origin.
• Extraskeletal lesions are seen in 50% of cases, with
retroperitoneal involvement seen in 1/3rd.
• Radiography shows
characteristics bilateral
symmetric osteosclerosis of
the metaphyseal diaphyseal
region of the long bones, with
sparing of the epiphysis and
lesser involvement of the flat
bones and axial skeleton.
68. • Retroperitoneal involvement with Erdheim-chester
disease characteristically produced a soft tissue rind
of fibrous perinephritis surrounding the kidneys and
ureters ,which can result in renal failure.
69. Extramedullary hematopoiesis
• seen in hemoglobinopathies,myelofibrosis,leukemia,lymphoma
and carcinoma.
• The typical CT appearance is hyper or isoattenuating round or
lobulated masses in the paravertebral region with or without
macroscopic fat.
70. • The MRI appearance is variable:
• Low signal intensity can be seen on T1WI and
T2WI because of the red marrow or hemosiderin
content.
• High signal intensity maybe found on T1WI and
T2WI because of fatty tissue.
• Enhancement is variable and often mild and
there is no associated bone destruction or
calcification.
72. Cystic neoplastic masses
cystic change in solid neoplasms.
• Cystic changes may develop in solid lesions such as
paragangliomas and neurilemomas
• Cytic teratoma.
• CT shows a complex cystic mass with areas of fat and
calcification.
Lymphangioma:
• Lymphangioma is a developmental malformation that is
caused by failure of communication of reteroperitoneal
lymphatics tissue with the main lymphatic vessels.
73. Lymphangoima
• It can be seen in perirenal ,
pararenal or pelvic
extraperitoneal spaces and can
involve more than one
compartment.
• CT scan shows large thin walled
unilocular or multilocular cystic
mass with attenuation values
ranging from that of fat (
caused by chyle) to that of fluid
• Calcification is rarely seen .
74. • An elongated shape with involvement of
multiple compartments are salient features of
lymphangiomas , particularly those prone to
recurrence.
• The occurrence of septa,compression of
intestinal loops and lack of fluid in dependant
recesses and mesenteric leaves differentiate
lymphangioma from ascites.
75. Mucinous cystadenoma is a rare primary epithelial
retroperitoneal tumor that is believed to arise:
(a) secondary to invagination of peritoneal mesothelium with
subsequent mucinous metaplasia and
cyst formation,
(b) as a result of ectopic ovarian tissue,
(c) from a teratoma with single mucinous cell lineage, or
(d) from remnants of the embryonic urogenital apparatus.
Asymptomatic and is seen in women with normal ovaries.
Histologically, mucinous cystadenoma
has a single layer of tall columnar epithelial cells.
Mucinous cystadenoma
76. CT and MR imaging show a well-defined unilocular homogeneous cystic mass
This cyst requires surgical resection because of the risk of malignant transformation
Mucinous cystadenoma of the retroperitoneum in a 39-year-old woman.
Axial CT image of the
abdomen shows that a nonspecific well-defined unilocular simple cyst
(arrow) in the right retroperitoneal space
is displacing the colon anteriorly
77. Cystic nonneoplastic masses
Hematoma
• Reteroperitnoeal hematoma can have a variable imaging
appearance ,depending on its stage.
• Acute and subacute hematoma have heterogenous high
attenuation on CT and maybe hyperintense on T1WI and
T2WI .
• Chronic hematoma have low attenuation on CT images and
high signal intensity on MRI because of hemosiderin
deposition.
79. Urinoma
• A well defined cystic lesion seen in retroperitoneum
, more common in the perirenal space.
• CT shows a well defined fluid collection, with
progressively increasing attenuation caused by
contrast enhanced urine entering the urinoma.
80. Urinoma in a 42-year-old man who had been in a motor vehicle accident. (a) Axial contrast-en
CT image obtained after the accident shows renal injury, with a hematoma (arrowhead) poste
collection (arrows) in the right anterior pararenal space. (b) Delayed axial contrast-enhanced C
the hematoma (arrowhead) and now shows the fluid collection filling with contrast material (a
the kidneys, a finding that indicates that this is a urinoma
81. Pancreatic pseudocyst
• It is a collection of pancreatic fluid that occurs secondary
to acute pancreatitis
• CT shows a well defined round or oval fluid collection
with enhancing wall.
Pancreatic pseudocyst in a 37-year-old
man with acute pancreatitis. Axial CT
image shows
edema (curved arrow) in the
peripancreatic region
and a unilocular cystic collection
(straight arrow) in the left anterior
pararenal space, a finding that is
consistent with a pancreatic
pseudocyst. Analysis of the fluid
obtained at aspiration of the cyst
revealed amylase in the cystic
collection.
85. Conclusions
Retroperitoneal masses can arise from various
tissues and are a diverse group, including some
rare neoplasms.
CT and MR imaging are valuable in the evaluation of retroperitoneal m
Although a specific diagnosis might be difficult to determine because o
in narrowing the differential diagnosis.