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Background To analyze the anatomical partitioning of the retroperitoneal space and determine the distribution patterns of primary retroperitoneal neurogenic tumors (PRNTs). Methods Retrospectively analyze the clinical data and CT data of 401 patients with single-injection PRNT confirmed by surgical pathology, including 103 cases of neuroendocrine origin, 148 cases of neuroectodermal origin, and 150 cases of peripheral nerve origin. The retroperitoneal space was divided into the anterior pararenal space, posterior pararenal space, perirenal space, and great vessel space. The anatomical location of each PRNT was determined using axial CT images, and distribution patterns of PRNTs with different pathological properties were analyzed. Results There were statistically significant differences in the distribution of benign and malignant PRNTs ( p  < 0.01), PRNTs from different tissues ( p  < 0.01), and PRNTs of different pathological types ( p  < 0.01) in different anatomical divisions. The occurrence of PRNTs varied significantly by age group, with statistically significant differences across pathological types ( p  < 0.01). Conclusion The anatomical distribution of PRNT could provide an effective imaging basis for the diagnosis and differential diagnosis of PRNT, aiding in more accurate clinical assessment and treatment planning.

While post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) benefits patients with teratoma or viable germ cell tumors (GCT), it becomes overtreatment if necrosis is detected in PC-RPLND specimens. Serum microRNA-371a-3p correctly predicts residual viable GCT with 100% sensitivity; however, prediction of residual teratoma in PC-RPLND specimens using current modalities remains difficult. Therefore, we developed a machine learning model using CT imaging and clinical variables to predict the presence of residual teratoma in PC-RPLND specimens. This study included 58 patients who underwent PC-RPLND between 2005 and 2019 at the University of Tsukuba Hospital. On CT imaging, 155 lymph nodes were identified as regions of interest (ROIs). The ResNet50 algorithm and/or Support Vector Machine (SVM) classification were applied and a nested, 3-fold cross-validation protocol was used to determine classifier accuracy. PC-RPLND specimen analysis revealed 35 patients with necrosis and 23 patients with residual teratoma, while histology of 155 total ROIs showed necrosis in 84 ROIs and teratoma in 71 ROIs. The ResNet50 algorithm, using CT imaging, achieved a diagnostic accuracy of 80.0%, corresponding to a sensitivity of 67.3%, a specificity of 90.5%, and an AUC of 0.84, whereas SVM classification using clinical variables achieved a diagnostic accuracy of 74.8%, corresponding to a sensitivity of 59.0%, a specificity of 88.1%, and an AUC of 0.84. Our machine learning models reliably distinguish between necrosis and residual teratoma in clinical PC-RPLND specimens.

Extraskeletal osteosarcoma (ESOS) is an extremely rare malignancy with poor prognosis, accounting for 2–4% of all osteogenic sarcomas. The purpose of this study was to examine the oncological outcomes of this disease related to surgical treatment and/or combined adjuvant therapies and to analyze the associated prognostic factors in ESOS. From January 1990 to June 2016, 22 patients with primary ESOS were analyzed in this retrospective study. Overall survival (OS) and progression-free survival (PFS) rates were calculated by Kaplan-Meier methods and compared with log-rank test. 22 patients were diagnosed with ESOS, 19 showed localized diseases and 3 presented with metastatic lesions. The median age at diagnosis was 55.5 years. Surgery resection was performed for all patients, 18 of whom received adjuvant chemotherapy. The median follow-up time was 48.5 months. There were 10 cases of recurrence and 9 patients developed new metastases. The 5-year OS rate for all patients was 58%. For localized cohort, the 5-year OS rate was 62%, and the 3-year PFS rate was 31% with a median PFS of 16 months. Univariate analysis of related prognosis factors showed that larger size of tumor (>5.5 cm) and higher histologic grade emerged as significant factors associated with worse OS. The addition of combination chemotherapy has no effect found on OS or PFS in this study. In summary, for patients who presented with ESOS, larger tumor size and higher histologic grade indicate a lower OS rate. The combination chemotherapy does not improve the OS or PFS.

Purpose of ReviewThis narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions.Recent FindingsRPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND.SummaryIn the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.

Background Retroperitoneal lymph node metastasis (rLNM) of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) represents a distinct metastatic state. Due to the unclear efficacy and side effects of radiotherapy in the treatment of these patients.This study aimed to assess the efficacy and adverse effects of radiotherapy combined with systemic therapy in rLNM patients after RNU. Methods A total of 114 UTUC patients with retroperitoneal LNM after RNU were prospectively enrolled database with retroperitoneal LNM after RNU. Patients were classified by initial treatment type: (1) radiation therapy, (2) systemic therapy or (3) combination therapy. Cox proportional hazard models were used to assess the factors associated with progression free survival (PFS) and overall survival (OS). Survival curves for each group were generated and compared via the Kaplan‒Meier method. Results A total of 114 rLNM patients with a median recurrence-free interval of 8 months after surgery (range: 1–108) were analyzed. During the median follow-up of 22 months (range: 3–81 months), 60 patients (58.8%) developed distant metastases. The para-aortic region was the most frequent site of recurrence. The recurrence rate in this region was significantly higher in patients with renal pelvic and proximal ureteral tumors (UTUCs) than in those with middle and distal UTUCs ( P  = 0.046). The common iliac region was the second most common recurrence site. Compared with renal pelvic tumors, ureteral tumors were more likely to recur in the common iliac region ( P  = 0.001). We delineated the radiotherapy clinical target volume (CTV) on the basis of primary tumor site; only 3 patients developed in-field recurrence during follow-up.The 2-year PFS rates for the combination therapy, radiation therapy and systemic therapy groups were 65.7%, 21.1% and 20.2%, respectively ( P  < 0.001). The 2-year OS rates for the combination therapy, radiation therapy and systemic therapy groups were 87.9%, 48.1% and 45.6%, respectively ( P  < 0.001). Multivariate analysis revealed that combination therapy,radiotherapy beginning within 3 months after recurrence and maintenance therapy after radiation were independent predictors of PFS. Maintenance therapy after radiation and distant metastasis were significant predictors of OS. Among 55 patients, 1 patient (1.8%) experienced acute grade 3 adverse events during combination therapy. Conclusions Systemic therapy and radiotherapy improved PFS compared with either therapy type alone in rLNM UTUC patients.The majority of patients experiencing only grade 1–2 gastrointestinal reactions.

Retroperitoneal ectopic pregnancy is an extremely rare form of ectopic pregnancy that can be life-threatening due to severe intra-abdominal hemorrhage. Retroperitoneal ectopic pregnancy is frequently misdiagnosed because of its atypical location and nonspecific symptoms. To the best of our knowledge, no previous cases of ectopic pregnancy localized to the mesorectum have been reported to date. Here, we present the case of a woman in her mid-30s with retroperitoneal ectopic pregnancy localized to the mesorectum. The condition was initially misdiagnosed as gastroenteritis due to atypical symptoms, which resulted in delayed treatment. This study aimed to improve the clinical recognition of mesorectal ectopic pregnancy among physicians.

Introduction Extrarenal Wilms tumor is an extremely rare condition, typically documented only in isolated case reports. Unlike classical intrarenal Wilms tumors, extrarenal Wilms tumors arise outside the kidney, often presenting a diagnostic challenge owing to its unusual location and overlapping features with other retroperitoneal tumors. Its rarity necessitates further documentation to improve recognition and management. This report presents a case of extrarenal Wilms tumor located in the retroperitoneal space of a 6-year-old girl. Case presentation A 6-year-old white Iranian girl presented with abdominal pain and swelling in the upper left abdomen. Physical examination revealed a firm, nontender, immobile mass. Ultrasound imaging identified a well-defined mass with significant necrotic and cystic areas. Abdominopelvic computed tomography scan showed a large mass on the left side of the abdomen, exerting pressure on the adjacent pancreas, spleen, and left kidney. The patient underwent laparotomy and received 19 weeks of chemotherapy, including actinomycin-D and vincristine. Post-treatment, she fully recovered and underwent monthly sonography follow-ups for 6 months after completing chemotherapy and has shown no signs of recurrence to date. Conclusions Extrarenal Wilms tumor should be considered in the differential diagnosis of abdominal pain, especially in young children, owing to its rarity and the potential for misdiagnosis as other retroperitoneal tumors. A definitive diagnosis is made through surgical intervention followed by histopathological examination.

The robotic retroperitoneal approach for renal mass surgery was introduced in 2018 at the Department of Urology in the clinic of Leverkusen, Germany. Clinical criteria for the choice of the access site (trans- vs. retroperitoneal) are not clearly defined. The aim of this study was to explore the learning curve and the impact of the access site on clinical outcome, in order to elucidate which preoperative clinical criteria should be taken into account when choosing the renal approach site. This retrospective study included 107 patients who underwent robotic tumor surgery between June 2018 and March 2022 at the Department of Urology in the Clinic of Leverkusen, Germany. Data from 86 patients with transperitoneal robotic surgery of the kidney and 21 patients with retroperitoneal access were available for analysis. We evaluated the data of patients in a trans- and a retroperitoneal access group. The preoperative clinical data included anthropomorphic data, the Body Mass Index (BMI) as well as the Preoperative Aspects and Dimensions Used for Anatomical Classification of Renal Masses (PADUA) - score. Intraoperative and postoperative data such as blood loss, clamping time, renal function and the learning curve of the surgeons was used to evaluate the outcomes of the two groups. Operation time in the retroperitoneal group was significantly shorter (p=0.015). Operation-specific variables showed no significant difference between the two groups. PADUA score and hilar clamping time showed no difference (p=0.345 and p=0.130, respectively). The learning curve in the retroperitoneal access group unveiled a noticeable difference in the experience and mastery of the involved surgeons. Mastery of the retroperitoneal approach is readily possible for surgeons with previous experience in robotic renal surgery without compromising the operative morbidity. The PADUA-score seems most suitable as a preoperative clinical criterion for choosing the renal approach site.

To explore the feasibility and safety of retroperitoneal laparoscopic resection of paraganglioma (RLPG) in a large study population. In a six-year period, 49 patients with primary retroperitoneal paragangliomas (PG) underwent retroperitoneal laparoscopic surgery in a single center. Medical records were reviewed, and collected the following data, which were clinical characteristics, perioperative data (operative time, estimated blood loss, intraoperative hemodynamic changes, intraoperative and postoperative complications, and open conversions), and follow-up data (recurrence or distant metastases). All PGs were removed with negative tumor margin confirmed by postoperative histopathology. The operative time of RLPG was 101.59±31.12 minutes, and the estimated blood loss was 169.78±176.70ml. Intraoperative hypertensive and hypotensive episodes occurred in 25 cases and 27 cases, respectively. Two open conversions occurred. Two intraoperative complications occurred but were successfully managed endoscopically. Postoperative complications were minor and unremarkable. No local recurrence or distant metastasis were observed during the follow-up period. Our experience indicates the feasibility and safety of resection of PGs in a relatively large study population.

Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.