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Retroperitoneal Soft Tissue Tumors (RSTT) with crural
extension in the thigh: a rare and difficult diagnosis Matter M*, Romain B*, Zingg T*, Cherix S**, Demartines N*.
*Visceral Surgery, **Orthopaedic & Trauma Surgery. 1011 Lausanne CHUV
Age, sex
BMI
Symptoms CT-scan Biopsy Surgery Definitive histology
Size (cm.)
Follow-up
61, F
27
Dysesthesia right femoral nerve
Inguinal mass
Psoas + crural Lipoma Right iliac fossa + crural
+ mesh
Lipoma
23 x 12 x 4
Recovery neurological
symptoms
69, M
33
Paresia right thigh with
muscular atrophy
Psoas + crural Liposarcoma
Grade I
Right iliac fossa + crural + kidney +
mesh
Grade I liposarcoma
“Lipoma-like”
27 x 18 x 10 & 23 x 16 x 6
Slow recovery
Motor & sensitive
42, F
30
Thigh weakness
Pain right iliac fossa
Psoas + crural Hibernoma Laparotomy
+ crural + mesh
Hibernoma
20 x 10 x 5
Recovery
Weakness
68, M
41
Suspicion deep v. thrombosis
Oedema ++
Psoas + crural
Compression femoral vein
Lipoma Laparotomy
+ crural + mesh
Lipoma
15 x 15 x 5
Rapid decrease of
Oedema
70, M
XX
Asymptomatic left inguinal mass
Past surgery for prostate cancer
Psoas + crural
+ inguinal
Liposarcome Laparotomy + crural / inguinal
+ kidney + left colon + mesh
Grade I Liposarcoma Uneventful recovery
Material & method. ResultsRetrospective study 2013-2016. Out of 63 patients with abdominal STS of which 36 patients with RSTT, 5 patients presented with
crural extension of RSTT (table 1). Median operative time was 167 min. (78 - 405) and the median Hospital stay 9 days (8 - 17).
Discussion and conclusion
RSTTs need a preoperative histological diagnosis in order to plan surgery for reaching R0 in case of malignancy. Even benign disease will mean large dissections and mesh reconstruction is the rule. Crural extension of RSTT is a further challenge because through compression it can mimic neurological or vascular pathologies.
In case of unexplained longstanding lower limb symptoms, work-up with an abdomino-pelvic CT-scan should be performed. Biopsy prior any treatment must be the rule
References
1. Mastrangelo G.Cancer 2012, 118:5339-5348
2. Bonvalot S. Ann Surg Oncol 2012, 19:2981–2991
3. Baldini EH. Int J Radiation Oncol Biol Phys 2015, 92:602-12
IntroductionSoft tissue tumors include benign tumors and soft tissue sarcomas (STS). Incidence is low with about 200 STS overall in
Switzerland. Retroperitoneal sarcomas represents 0.65 / 100’000 (1).
Retroperitoneal soft tissue tumors (RSTT) are difficult and rare entities. Challenges include:
- unspecific clinical presentation,
- uncertain malignancy and the need for large radical multivisceral en-bloc surgery with complex reconstructions
- possible extension and protrusion through well-known hernia orifices (mediastinal hiatus, inguinal, sciatic, crural for example) (2)
- Surgical approach
- unknown need for induction therapy (no proven survival advantage so far for chemotherapy, radiotherapy or thermotherapy) (3)
42, F
68, M
61, F
70, M
69, M