Skip to main content

Retroperitoneal Tumors

  • Chapter
  • First Online:
Oncologic Imaging: Urology

Abstract

The retroperitoneum is a large compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia (Fig. 6.1). The abdominal retroperitoneum is divided by the fascial planes into three distinct compartments: the anterior pararenal, the perirenal, and the posterior pararenal spaces. The anterior and posterior pararenal spaces merge inferior to the level of the kidneys, which communicates inferiorly with the prevesical space and extraperitoneal compartments of the pelvis [1]. Retroperitoneal tumors represent a broad, diverse group of benign and malignant lesions, which may be primary or secondary in origin [2]. Primary tumors of the retroperitoneum develop independently from cells distinct from the major retroperitoneal organs such as the kidneys, adrenal glands, pancreas, colon and duodenum, and major blood vessels. The majority of retroperitoneal tumors arise from retroperitoneal organs and are therefore not considered primary retroperitoneal tumors [3].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush Jr WH, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics. 2011;31:949–76.

    Article  PubMed  Google Scholar 

  2. Osman S, Lehnert BE, Elojeimy S, Cruite I, Mannelli L, Bhargava P, Moshiri M. A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol. 2013;42(5):191–208.

    Article  PubMed  Google Scholar 

  3. Scali EP, Chandler TM, Heffernan EJ, Coyle J, Harris AC, Chang SD. Primary retroperitoneal masses: what is the differential diagnosis? Abdom Imaging. 2015;40(6):1887–903.

    Article  PubMed  Google Scholar 

  4. Virseda Rodríguez JA, Donate Moreno MJ, Pastor Navarro H, Carrión López P, Martínez Ruiz J, Martínez Sanchiz C, Perán Teruel M. Primary retroperitoneal tumors: review of our 10-year case series. Arch Esp Urol. 2010;63(1):13–22.

    Article  PubMed  Google Scholar 

  5. Goenka AH, Shah SN, Remer EM. Imaging of the retroperitoneum. Radiol Clin North Am. 2012;50(2):333–55.

    Article  PubMed  Google Scholar 

  6. Heslin MJ, Lewis JJ, Nadler E, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: Implications for management. J Clin Oncol. 1997;15:2832–9.

    CAS  PubMed  Google Scholar 

  7. Tambo M, Fujimoto K, Miyake M, Hoshiyama F, Matsushita C, Hirao Y. Clinicopathological review of 46 primary retroperitoneal tumors. Int J Urol. 2007;14(9):785–8.

    Article  PubMed  Google Scholar 

  8. Koh DM, Moskovic E. Imaging tumours of the retroperitoneum. Imaging. 2000;12:49–60.

    Article  Google Scholar 

  9. Solla JA, Reed K. Primary retroperitoneal sarcomas. Am J Surg. 1986;152:496–8.

    Article  CAS  PubMed  Google Scholar 

  10. Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg. 1991;214:2–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Elsayes KM, Staveteig PT, Narra VR, Chen ZM, Moustafa YL, Brown J. Retroperitoneal masses: magnetic resonance imaging findings with pathologic correlation. Curr Probl Diagn Radiol. 2007;36(3):97–106.

    Article  PubMed  Google Scholar 

  12. Nishino M, Hayakawa K, Minami M, et al. Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues. Radiographics. 2003;23:45–57.

    Article  PubMed  Google Scholar 

  13. Sanyal R, Remer EM. Radiology of the retroperitoneum: case-based review. Am J Roentgenol. 2009;192:S112–7.

    Article  Google Scholar 

  14. Gustafson P, Herrlin K, Biling L, et al. Necrosis observed on CT enhancement is of prognostic value in soft tissue sarcoma. Acta Radiol. 1992;33(5):474–6.

    Article  CAS  PubMed  Google Scholar 

  15. Brennan C, Kajal D, Khalili K, Ghai S. Solid malignant retroperitoneal masses-a pictorial review. Insights Imaging. 2014;5(1):53–65.

    Article  PubMed  Google Scholar 

  16. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. Pathology and genetics of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013.

    Google Scholar 

  17. Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology. 2014;46(2):95–104.

    Article  CAS  PubMed  Google Scholar 

  18. Pham TH, Iqbal CW, Zarroug AE, Donohue JH, Moir C. Retroperitoneal sarcomas in children: outcomes from an institution. J Pediatr Surg. 2007;42(5):829–33.

    Article  PubMed  Google Scholar 

  19. Lewis JJ, Leung D, Woodruff JM, et al. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228(3):355–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Makela J, Kiviniemi H, Laitinen S. Prognostic factors predicting survival in the treatment of retroperitoneal sarcoma. Eur J Surg Oncol. 2000;26(6):552–5.

    Article  CAS  PubMed  Google Scholar 

  21. Swallow CJ, Catton CN. Local management of adult soft tissue sarcomas. Semin Oncol. 2007;34(3):256–69.

    Article  PubMed  Google Scholar 

  22. Neville A, Herts BR. CT characteristics of primary retroperitoneal neoplasms. Crit Rev Comput Tomogr. 2004;45(4):247–70.

    Article  PubMed  Google Scholar 

  23. Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94–109.

    Article  PubMed  Google Scholar 

  24. Kim T, Murakami T, Oi H, et al. CT and MR imaging of abdominal liposarcoma. Am J Roentgenol. 1996;166:829–33.

    Article  CAS  Google Scholar 

  25. Evans HL, Soule EH, Winkelmann RK. Atypical lipoma, atypical intramuscular lipoma, and well differentiated retroperitoneal liposarcoma: a reappraisal of 30 cases formerly classified as well differentiated liposarcoma. Cancer. 1979;43:574–84.

    Article  CAS  PubMed  Google Scholar 

  26. Fletcher CDM, Unni KK, Mertens F. WHO classification of tumours of soft tissue and bone. 3rd ed. Lyon: IARC Press; 2002.

    Google Scholar 

  27. Song T, Shen J, Liang BL, Mai WW, Li Y, Guo HC. Retroperitoneal liposarcoma: MR characteristics and pathological correlative analysis. Abdom Imaging. 2007;32:668–74.

    Article  PubMed  Google Scholar 

  28. Chang I-YJ, Herts BR. Retroperitoneal liposarcoma. J Urol. 2013;189:1093–4.

    Article  PubMed  Google Scholar 

  29. Kumarasamy NA, Gayer G. Retroperitoneal sarcomas. Semin Ultrasound CT MR. 2011;32:422–32.

    Article  PubMed  Google Scholar 

  30. Craig WD, Fanburg-Smith JC, Henry LR, Guerrero R, Barton JH. Fat-containing lesions of the retroperitoneum: radiologic-pathologic correlation. Radiographics. 2009;29(1):261–90.

    Article  PubMed  Google Scholar 

  31. Pereira JM, Sirlin CB, Pinto PS, et al. CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics. 2005;25:69–85.

    Article  PubMed  Google Scholar 

  32. Hartman DS, Hayes WS, Choyke PL, Tibbetts GP. From the archives of the AFIP. Leiomyosarcoma of the retroperitoneum and inferior vena cava: radiologic-pathologic correlation. Radiographics. 1992;12:1203–20.

    Article  CAS  PubMed  Google Scholar 

  33. Fletcher CD, Gustafson P, Rydholm A, Willen H, Akerman M. Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas:prognostic relevance of subclassification. J Clin Oncol. 2001;19:3045–50.

    CAS  PubMed  Google Scholar 

  34. O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer. 1964;17:1445–55.

    Article  PubMed  Google Scholar 

  35. Coindre JM, Mariani O, Chibon F, et al. Most malignant fibrous histiocytomas developed in the retroperitoneum are dedifferentiated liposarcomas: a review of 25 cases initially diagnosed as malignant fibrous histiocytoma. Mod Pathol. 2003;16(3):256–62.

    Article  PubMed  Google Scholar 

  36. Kim EE, Valenzuela RF, Kumar AJ, Raney RB, Eftekari F. Imaging and clinical spectrum of rhabdomyosarcoma in children. Clin Imaging. 2000;24:257–62.

    Article  CAS  PubMed  Google Scholar 

  37. Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics. 2003;23(5):1245–78.

    Article  PubMed  Google Scholar 

  38. van Rijswijk CS, Lieng JG, Kroon HM, Hogendoorn PC. Retroperitoneal extraskeletal osteosarcoma. J Clin Pathol. 2001;54(1):77–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003;23(1):29–43.

    Article  PubMed  Google Scholar 

  40. Hughes MJ, Thomas JM, Fisher C, Moskovic EC. Imaging features of retroperitoneal and pelvic schwannomas. Clin Radiol. 2005;60:886–93.

    Article  CAS  PubMed  Google Scholar 

  41. Otal P, Mezghani S, Hassissene S, et al. Imaging of retroperitoneal ganglioneuroma. Eur Radiol. 2001;11(6):940–5.

    Article  CAS  PubMed  Google Scholar 

  42. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 2002;22(4):911–34.

    Article  PubMed  Google Scholar 

  43. Hruby G, Lehman M, Barton M, Peduto T. Malignant retroperitoneal paraganglioma: case report and review of treatment options. Australas Radiol. 2000;44:478–82.

    Article  CAS  PubMed  Google Scholar 

  44. Feng N, Zhang W-Y, Wu X-T. Clinicopathological analysis of paraganglioma with literature review. World J Gastroenterol WJG. 2009;15(24):3003–8.

    Article  PubMed  Google Scholar 

  45. Scholz M, Zehender M, Thalmann GN, Borner M, Thöni H, Studer UE. Extragonadal retroperitoneal germ cell tumor: evidence of origin in the testis. Ann Oncol. 2002;13(1):121–4.

    Article  CAS  PubMed  Google Scholar 

  46. Keitoku M, Konishi I, Nanbu K, et al. Extraovarian sex cord-stromal tumor: case report and review of the literature. Int J Gynecol Pathol. 1997;16(2):180–5.

    Article  CAS  PubMed  Google Scholar 

  47. Balfe DM, Mauro MA, Koehler RE, et al. Gastrohepatic ligament: normal and pathologic CT anatomy. Radiology. 1984;150(2):485–90.

    Article  CAS  PubMed  Google Scholar 

  48. Dorfman RE, Alpern MB, Gross BH, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology. 1991;180(2):319–22.

    Article  CAS  PubMed  Google Scholar 

  49. Einstein DM, Singer AA, Chilcote WA, et al. Abdominal lymphadenopathy: spectrum of CT findings. Radiographics. 1991;11(3):457–72.

    Article  CAS  PubMed  Google Scholar 

  50. Coakley FV, Hricak H. Imaging of peritoneal and mesenteric disease: key concepts for the clinical radiologist. Clin Radiol. 1999;54(9):563–74.

    Article  CAS  PubMed  Google Scholar 

  51. Zhou LP, Zhang B, Peng WJ, Yang WT, Guan YB, Zhou KR. Imaging findings of Castleman disease of the abdomen and pelvis. Abdom Imaging. 2008;33:482–8.

    Article  CAS  PubMed  Google Scholar 

  52. Kim TJ, Han JK, Kim YH, Kim TK, Choi BI. Castleman disease of the abdomen: imaging spectrum and clinicopathologic correlations. J Comput Assist Tomogr. 2001;25:207–14.

    Article  CAS  PubMed  Google Scholar 

  53. Brian J, Douglas P. Erdheim-Chester disease of the retorperitoneum. Am J Roentgenol. 2001;176:1130–1.

    Google Scholar 

  54. Yang DM, Jung DH, Kim H, Kang JH, Kim SH, Kim JH, Hwang HY. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics. 2004;24(5):1353–65.

    Article  PubMed  Google Scholar 

  55. Davidson AJ, Hartman DS. Lymphangioma of the retroperitoneum: CT and sonographic characteristic. Radiology. 1990;175(2):507–10.

    Article  CAS  PubMed  Google Scholar 

  56. Banerjee R, Gough J. Cystic mucinous tumours of the mesentery and retroperitoneum: report of three cases. Histopathology. 1988;12:527–32.

    Article  CAS  PubMed  Google Scholar 

  57. Lee SA, Bae SH, Ryoo HM, Jung HY, Jang SB, Kum YS. Primary retroperitoneal mucinous cystadenocarcinoma: a case report and review of the literature. Korean J Intern Med. 2007;22(4):287–91.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Singer S, Antonescu CR, Riedel E, et al. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003;238(3):358–70; discussion 370–351.

    PubMed  PubMed Central  Google Scholar 

  59. de Vreeze RS, de Jong D, Tielen IH, et al. Primary retroperitoneal myxoid/round cell liposarcoma is a nonexisting disease: an immunohistochemical and molecular biological analysis. Mod Pathol Off J U S Can Acad Pathol Inc. 2009;22(2):223–31.

    Google Scholar 

  60. Geoerger B, Hero B, Harms D, et al. Metabolic activity and clinical features of primary ganglioneuromas. Cancer. 2001;91(10):1905–13.

    Article  CAS  PubMed  Google Scholar 

  61. Mirilas P, Skandalakis JE. Surgical anatomy of the retroperitoneal spaces, part V: surgical applications and complications. Am Surg. 2010;76(4):358–64.

    PubMed  Google Scholar 

  62. Van Roggen JF, Hogendoorn PC. Soft tissue tumours of the retroperitoneum. Sarcoma. 2000;4(1–2):17–26.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Strauss DC, Hayes AJ, Thway K, Moskovic EC, Fisher C, Thomas JM. Surgical management of primary retroperitoneal sarcoma. Br J Surg. 2010;97(5):698–706.

    Article  CAS  PubMed  Google Scholar 

  64. Strauss DC, Hayes AJ, Thomas JM. Retroperitoneal tumours: review of management. Ann R Coll Surg Engl. 2011;93(4):275–80.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Neuhaus SJ, Barry P, Clark MA, Hayes AJ, Fisher C, Thomas JM. Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg. 2005;92(2):246–52.

    Article  CAS  PubMed  Google Scholar 

  66. Bonvalot S, Rivoire M, Castaing M, Stoeckle E, Le Cesne A, Blay JY, Laplanche A. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(1):31–7.

    Article  Google Scholar 

  67. Gronchi A, Lo Vullo S, Fiore M, Mussi C, Stacchiotti S, Collini P, Lozza L, Pennacchioli E, Mariani L, Casali PG. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(1):24–30.

    Article  Google Scholar 

  68. Anaya DA, Lahat G, Wang X, Xiao L, Tuvin D, Pisters PW, Lev DC, Pollock RE. Establishing prognosis in retroperitoneal sarcoma: a new histology-based paradigm. Ann Surg Oncol. 2009;16(3):667–75.

    Article  PubMed  Google Scholar 

  69. Gubbay AD, Moschilla G, Gray BN, Thompson I. Retroperitoneal schwannoma: a case series and review. Aust N Z J Surg. 1995;65(3):197–200.

    Article  CAS  PubMed  Google Scholar 

  70. Cury J, Coelho RF, Srougi M. Retroperitoneal schwannoma: case series and literature review. Clinics. 2007;62(3):359–62.

    Article  PubMed  Google Scholar 

  71. Lehnert T, Cardona S, Hinz U, Willeke F, Mechtersheimer G, Treiber M, Herfarth C, Buechler MW, Schwarzbach MH. Primary and locally recurrent retroperitoneal soft-tissue sarcoma: local control and survival. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2009;35(9):986–93.

    CAS  Google Scholar 

  72. Hassan I, Park SZ, Donohue JH, Nagorney DM, Kay PA, Nasciemento AG, Schleck CD, Ilstrup DM. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg. 2004;239(2):244–50.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Tseng WW, Wang SC, Eichler CM, Warren RS, Nakakura EK. Complete and safe resection of challenging retroperitoneal tumors: anticipation of multi-organ and major vascular resection and use of adjunct procedures. World J Surg Oncol. 2011;9:143.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Russo P, Kim Y, Ravindran S, Huang W, Brennan MF. Nephrectomy during operative management of retroperitoneal sarcoma. Ann Surg Oncol. 1997;4(5):421–4.

    Article  CAS  PubMed  Google Scholar 

  75. Schwarzbach MH, Hormann Y, Hinz U, Leowardi C, Bockler D, Mechtersheimer G, Friess H, Buchler MW, Allenberg JR. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg. 2006;44(1):46–55.

    Article  PubMed  Google Scholar 

  76. Sarkar R, Eilber FR, Gelabert HA, Quinones-Baldrich WJ. Prosthetic replacement of the inferior vena cava for malignancy. J Vasc Surg. 1998;28(1):75–81; discussion 82–73.

    Article  CAS  PubMed  Google Scholar 

  77. Kieffer E, Alaoui M, Piette JC, Cacoub P, Chiche L. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg. 2006;244(2):289–95.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Zhang Z, Xiu D. Laparoscopic surgery for primary retroperitoneal tumors: a single institution experience of 14 cases. Surg Laparosc Endosc Percutan Tech. 2010;20(6):399–403.

    Article  CAS  PubMed  Google Scholar 

  79. Ahn KS, Han HS, Yoon YS, Kim HH, Lee TS, Kang SB, Cho JY. Laparoscopic re0ion of nonadrenal retroperitoneal tumors. Arch Surg. 2011;146(2):162–7.

    Article  PubMed  Google Scholar 

  80. Ball AJ, Siddiq FM, Garcia M, Ganjei-Azar P, Leveillee RJ. Hand-assisted laparoscopic removal of retroperitoneal liposarcoma. Urology. 2005;65(6):1226.

    Article  PubMed  Google Scholar 

  81. Dalpiaz O, Gidaro S, Lipsky K, Schips L. Case report: laparoscopic removal of 10-cm retroperitoneal liposarcoma. J Endourol Endourol Soc. 2007;21(1):83–4.

    Article  Google Scholar 

  82. Viani MP, Poggi RV, Pinto A, Maruotti RA. Gasless laparoscopic removal of retroperitoneal leiomyosarcoma. J Laparoendosc Surg. 1995;5(1):47–54.

    Article  CAS  PubMed  Google Scholar 

  83. Agresta F, De Simone P, Michelet I, Bedin N. Retroperitoneal leiomyosarcoma mimicking acute appendicitis: laparoscopic management. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg. 2003;7(2):177–9.

    Google Scholar 

  84. Park MJ, Seo KN, Kang HJ. Neurological deficit after surgical enucleation of schwannomas of the upper limb. J Bone Joint Surg. 2009;91(11):1482–6.

    Article  CAS  Google Scholar 

  85. Sawada T, Sano M, Ogihara H, Omura T, Miura K, Nagano A. The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas. J Hand Surg. 2006;31(6):629–34.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Chang Kyu Sung or Bohyun Kim .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sung, C.K., Kim, B., Moon, K.C., Ku, J.H., Ha, S.B. (2017). Retroperitoneal Tumors. In: Kim, S., Cho, J. (eds) Oncologic Imaging: Urology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45218-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45218-9_6

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45217-2

  • Online ISBN: 978-3-662-45218-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics