Cases reported "Retroperitoneal Neoplasms"

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1/11. The use of bonewax to control massive presacral bleeding.

    Massive presacral bleeding during retroperitoneal resection is unusual, and can be difficult to control. We describe a technique for managing this complication whereby bonewax is pushed through the presacral fascia and periosteum directly into the bleeding point in the sacrum, followed by abdominal packing. This maneuver proved successful for achieving hemostasis when we recently encountered this intraoperative complication.
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keywords = sacrum
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2/11. Nerve sheath tumors involving the sacrum. Case report and classification scheme.

    Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.
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ranking = 9
keywords = sacrum
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3/11. Presacral neurilemoma (schwannoma)--report of a rare case.

    A rare case of presacral neurilemoma is reported herein. Despite the large size of the tumor and the extensive destruction of the sacrum, the patient was almost asymptomatic. Accurate diagnosis depends on careful rectal examination and computerized axial tomography is the most useful single investigation. Surgery is the only treatment and for large lesions, the abdominal approach is usually preferred. recurrence is rare and patients live a long, symptom free life even after partial resection.
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ranking = 1
keywords = sacrum
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4/11. Retroperitoneal liposarcoma simulating a prolapsed intervertebral disc. A case report.

    A metastatic liposarcoma presented with the clinical features of a prolapsed intervertebral disc. The tumour had spread from the retroperitoneal space in front of the sacrum by way of the first sacral foramen and along the dural sleeve of the first sacral root. Such a presentation has not previously been reported, and we make the point that it is important always to send material removed during operation on discs for histological examination.
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ranking = 1
keywords = sacrum
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5/11. chondroblastoma of the sacrum. A case report.

    death due to a chondroblastoma of the sacrum is uncommon. We report the case of a 48-year-old man with this condition. During a 10-year period, the tumor spread into the retroperitoneal space and was an enormous mass after repeated radiotherapy. The patient died of renal failure. The tumor was histologically benign even at autopsy.
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ranking = 5
keywords = sacrum
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6/11. Preoperative embolization of retroperitoneal hemangiopericytomas as an aid in their removal.

    The first reported cases of preoperatively embolized hemangiopericytomas are presented. Both lesions presented in the retroperitoneum where most lesions are now considered to be malignant. In the past, the highly vascular nature of these tumors has made resection in these areas difficult. Since the angiographic picture of hemangiopericytomas is now thought to be specific, it became feasible to add preoperative embolization to the overall management of these cases. In the first case, the diagnosis had been established 15 years previously. When first seen at Thomas Jefferson University Hospital, extensive bone destruction of the sacrum and lumbar vertebrae were present. Preoperative Gelfoam embolization aided in the palliative debulking of the tumor at operation. With this experience, preoperative embolization became part of the management in the second case and aided in the complete surgical removal of the tumor. radiation therapy in the dosage of 5000 rad was given postoperatively in this case and should also be part of the treatment plan for these lesions.
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ranking = 1
keywords = sacrum
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7/11. Computed tomography in recurrent or metastatic colon cancer: relation to rising serum carcinoembryonic antigen.

    Twenty patients with Stage Duke B or C adenocarcinoma of the colon or rectum who have undergone radical surgical resection and demonstrated rising serum carcinoembryonic antigen (CEA) during follow-up are the subject of this study. In all cases, while there was a continuous and progressive elevation of serum CEA, CT examination of the abdomen and pelvis was performed. Abnormal CT findings were demonstrated in 19 patients and included pelvic mass, liver metastases, and periaortic or mesenteric lymphadenopathy. There was one normal CT scan in a patient who subsequently developed metastases in the sacrum. Based on the observations in these patients, it is concluded that in routine follow-up after colorectal surgery, rising serum CEA should be considered a warning sign and warrants additional investigation by CT.
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ranking = 1
keywords = sacrum
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8/11. Malignant neurilemmoma of left atrium.

    A 31-year-old woman, whose chief complaint was back pain, was found to have an echocardiographic abnormality suggestive of a left atrial myxoma. angiography clearly showed a large radiolucent mass protruding from the left atrium into the left ventricle during diastole. x-rays of the sacrum disclosed the presence of a malignant tumour. biopsy specimens taken from the tumour in the sacral plexus showed a malignant neurilemmoma. Despite extensive chemotherapy, widespread metastases developed and the patient died four months after admission. Necropsy disclosed three discrete tumours in the left atrium, which were found to be malignant neurilemmoma, shown on histology to be metastases from the primary in the sacral plexus.
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ranking = 1
keywords = sacrum
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9/11. Partial sacral resection and reconstruction with bone cement. Discussion of an operative experience.

    Sacral resection is often the only way for effective palliation of the severe pain in tumors involving sacrum. However the operation hardly seems to be acceptable with the reported operative times, blood losses and complication rates. A case of retrorectal leiomyosarcoma invading sacrum, with severe pain resistant to combined irradiation and chemotherapy is reported. The tumor was removed with resection of the right two thirds of S2, S3 and S4, and the sacrum was reconstructed with bone cement. Complete relief of the pain was obtained with no postoperative complications. It is concluded that incomplete resection of the sacral vertebrae should be performed for sacral root pain palliation if other methods fail. Bone cement reconstruction seems to be a valuable alternative to muscle flaps in covering sacral defects.
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ranking = 3
keywords = sacrum
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10/11. Dural ectasia presenting as an adnexal mass.

    BACKGROUND: Dural ectasia associated with the sacrum is uncommon, even more so in presenting as an adnexal mass. CASE: A 49-year-old, postmenopausal women presented with the ultrasonographic finding of a complex left adnexal mass. Diagnostic laparoscopy revealed a 2-cm left ovarian cystic lesion and a 6-cm retroperitoneal mass. Subsequent laparotomy revealed bilateral, retroperitoneal, cystic masses attached to the anterior sacrum. Postoperative pelvic magnetic resonance imaging revealed multilevel dural ectasia involving the ventral foramina of the sacrum, with extension into the pelvis most prominent on the left at the S1-S2 level. CONCLUSION: Dural ectasia, as well as other growths of neurologic origin, should be considered in the differential diagnosis of the pelvic mass.
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ranking = 3
keywords = sacrum
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