Practical imaging approach to retroperitoneal sarcomas: a case-based review of diagnosis, staging and complications

Congress:

ECR 2020

Poster Number:

C-05760

Type:

Educational Exhibit

Keywords:

Oncologic Imaging, Abdomen, Retroperitoneum, CT, Complications, Staging, Surgery, Cancer, Not applicable

Authors:

A. Randazzo, R. Cannella, F. Vernuccio, G. Porrello, G. Brancatelli; Palermo/IT

DOI:

10.26044/ecr2020/C-05760

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05760

Fig. 1: Well-differentiated liposarcoma in 56-year-old man with abdominal pain. Axial...

Fig. 2: 53-year-old woman with liposarcoma. CT shows round solid mass with less...

Fig. 3: 49-year-old man with dedifferentiated liposarcoma. CT shows a large solid mass...

Fig. 4: 65-year-old man with leiomyosarcoma. CT images on the unenhanced, arterial,...

Learning objectives

To describe CT imaging features of retroperitoneal sarcomas, potential complications and patient management.

Background

Primary Retroperitoneal sarcomas represent 0.1-0.2% of malignant tumors. The most frequent subtypes are liposarcomas, leiomyosarcomas and malignant fibrous histiocytomas (MFH) accounting for more than 80% of primary retroperitoneal sarcomas [1]. Liposarcoma Liposarcoma is the most common primary retroperitoneal sarcoma, representing 35% of all malignant retroperitoneal soft-tissue tumors in adult patients. They are histologically subdivided into five main subgroups, in the order of increasing malignancy: well-differentiated myxoid dedifferentiated round cell pleomorphic liposarcoma. Leiomyosarcoma Leiomyosarcoma is the second most common retroperitoneal sarcoma and it is the most...

Findings and procedure details

Patients with retroperitoneal sarcomas may have non-specific abdominal discomfort, gastrointestinal symptoms, although many are asymptomatic or minimally symptomatic, when the tumors are large enough to produce local symptoms [3]. Metastases at initial presentation are uncommon. CT imaging: diagnosis and staging [3-4-5-6] These tumors are usually large at diagnosis and often involve adjacent structures. Chest, abdomen and pelvis contrast-enhanced CT is the gold standard imaging technique for initial staging. Pelvic MRI could be considered as additional option. Biopsy should be carried out for the management of...

Conclusion

Radiologists play a primary role in preoperative diagnosis and staging of retroperitoneal sarcomas, for detection of recurrence and assessment of postoperative complications. Many patterns of imaging are overlapped in retroperitoneal sarcomas. Specificimaging features with patterns of involvement, associated to clinical features and multidisciplinary approach through discussions in tumor board, can be useful to reach the diagnosis.

Personal information and conflict of interest

A. Randazzo; Palermo/IT - nothing to disclose R. Cannella; Palermo/IT - nothing to disclose F. Vernuccio; Palermo/IT - nothing to disclose G. Porrello; Palermo/IT - nothing to disclose G. Brancatelli; Palermo/IT - nothing to disclose

References

Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush WH Jr, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics. 2011; 31(4):949-76. Neville A, Herts BR. CT characteristics of primary retroperitoneal neoplasms. Crit Rev Comput Tomogr 2004;45(4):247–270. Casali PG, et al. ESMO Guidelines Committee and EURACAN. Soft tissue and visceral sarcomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up; Ann Oncol. 2018;29(Suppl 4):iv51-iv67. Francis IR, Cohan RH, Varma DG, Sondak VK. Retroperitoneal sarcomas. Cancer Imaging. 2005;5:89-94. Levy AD, Manning MA, Al-Refaie WB, Miettinen MM. Soft-Tissue...