Schwannoma retroperitoneal como diagnóstico diferencial de tumor retrocavo, reporte de un caso

Introducción: Los schwannomas suelen ser tumores benignos con origen en el sistema neural que sostiene la célula de Schwann. La mayoría presentan síntomas abdominales inespecíficos. Dado su escasa frecuencia, 1-5% de todos los tumores retroperitoneales en la población mundial, se presenta el siguiente caso. Pueden tener múltiples localizaciones, como el páncreas, tracto gastrointestinal y espacio retroperitoneal. Son pocos los casos que se han reportado siendo apenas notificados menos de 150 casos a la actualidad. Caso Clínico: Paciente femenina de 33 años con dolor abdominal inespecífico. Niega antecedentes relevantes y no presenta hallazgos positivos al examen físico. Estudios complementarios con tomografía y resonancia magnética nuclear de abdomen contrastados mostraron una masa retroperitoneal quística de 5x4 cm de localización suprarrenal derecha, que desplazaba la cava retrohepatica y que realza con medio contraste intravenoso. Debido a que el dolor era incapacitante se realizó resección quirúrgica. No se consideró biopsia preoperatoria, ante el riesgo de ruptura y diseminación tumoral. Se realizó escisión transperitoneal con resección completa, técnicamente compleja por su localización. El reporte histopato-lógico fue Schwannoma, sin tejido supra-adrenal, sugiriendo lesión yuxta-adrenal.

Introduction: Schwannomas are usually benign tumors originating in the neural system that supports the Schwann cell. Most have nonspecific abdominal symptoms. Given its low frequency, 1-5% of all retroperitoneal tumors in the world population, the following case is presented. They can have multiple locations, such as the pancreas, gastrointestinal tract and retroperitoneal space. Few cases have been reported, with less than 150 cases reported to date. Clinical Case: 33-year-old female patient with nonspecific abdominal pain. She denies relevant history and has no positive findings on physical examination. Complementary studies with contrast-enhanced tomography and magnetic resonance imaging of the abdomen showed a 5x4 cm cystic retroperitoneal mass located in the right suprarenal region, displacing the retrohepatic vena cava and enhancing with intravenous contrast medium. Because the pain was incapacitating, surgical resection was performed. A preoperative biopsy was not considered, given the risk of rupture and tumor dissemination. Transperitoneal excision was performed with complete resection, technically complex due to its location. The histopathological report was Schwannoma, without supra-adrenal tissue, suggesting a juxta-adrenal lesion.

Retrocaval Ureter with Proximal Hydroureteronephrosis Presenting as Flank Pain in a Child: A Rare Case Report with Review of Literature

Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureterpassing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptomsuntil the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with ahistory of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerizedtomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with reviewof recent literature.

Uréter retrocavo e infección recurrente de vías urinarias: A propósito de un caso / Retrocaval Ureter and Recurrent Urinary Tract Infection: Case Report

El uréter retrocavo es una anomalía poco frecuente de etiología congénita, la cual causa sintomatología en pacientes adultos; se caracteriza por hidronefrosis en diferentes grados, además de otras patologías relacionadas con lesión renal. El abordaje terapéutico es principalmente quirúrgico y se aplicará de acuerdo con el grado de disfunción renal. A continuación se presenta el caso de una mujer de 27 años de edad, a quien se le practicó un estudio imaginológico por infección recurrente de vías urinarias que no respondió a la farmacoterapia habitual.

Retrocaval ureter is a rare anomaly of congenital etiology, which causes symptoms in adults and is characterized by hydronephrosis in different degrees, in addition to other diseases related to renal injury. The therapeutic approach is mainly surgical and decided according to degree of related renal dysfunction. We present a case of a woman aged 27 who is sent to the radiology service of Hospital San Rafael Tunja for an imaging study after refractory urinary tract infection that did not respond to standard drug therapy

Retrocaval ureter and contra lateral renal agenesis – a case report and review of literature

ABSTRACT Associated congenital anomalies are seen in 21% of retrocaval ureter patients; among them, associated contralateral renal agenesis is a very rare entity. We report one such case of right circumcaval ureter with left renal agenesis, diagnosed after febrile UTI. Surgical correction with uretero-ureterostomy was successful. In literature very few such cases are reported and only one case with renal failure was reported. Unilateral renal agenesis cases complicated by associated such anomalies need definitive management and lifelong clinical monitoring to diagnose and prevent chronic kidney disease.

The application of trocar position adjustment in posterior laparoscopic in the treatment of retrocaval ureter / 中华泌尿外科杂志

Objective To introduce a new trocar position in the posterior laparoscopic for the treatment of retrocaval ureter.Methods From August 2011 to October 2014,5 cases with retrocaval ureter treated with posterior laparoscopic were retrospectively analyzed,including 3 males and 2 females,aged from 15 to 46 years(mean 34 years).The history of disease ranged from 1 to 10 months,with 3 cases presented with low back pain,and 2 cases being detected uronephrosis by check-up.Results All the operations were successfully completed,with the operation duration ranged from 75-125 min (mean 90min),and blood loss ranged from 20ml to 50 ml(mean 35 ml).The average hospital stay was 6 days(5-7d).There was no wound infection or urine leakage.Ureteral double-J tubes were removed 4 weeks after surgery.Postoperative followup ranged from 2 weeks to 6 months (mean 30 months).There was no anastomotic stricture,and the hydronephrosis relieved.Conclusions Trocar position adjustment of posterior laparoscopic in treatment of retrocaval ureter is convenient to operate,which also shortened the time of operation,reduced the difficulty of operation and the surgeons' fatigue.

Right sided double inferior vena cava with obstructed retrocaval ureter: Managed with single incision multiple port laparoscopic technique using "Santosh Postgraduate Institute tacking ureteric fixation technique"

Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.

Retrocaval Ureter: Report of 2 Different Clinical Spectrums

Retrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively.

Laparoscopic Resection of Retrocaval Non-functioning Paraganglioma

Retroperitoneal paraganglioma is located prim arily at the para-aortic area and functioning tumor, however, non-functioning and retrocaval located tumors are rare. Laparoscopic retrocaval paraganglioma resection is technically challenging due to vena cava close relation. A 49-year-old male was referred for a retroperitoneal tumor, detected by FDG-PET scan. He had undergone right thyroidectomy for papillary carcinoma one year ago. Abdominal computed tomography (CT) scan showed a mass measuring 2 cm in size located behind the inferior vena cava (IVC), which deviate IVC anteriorly. I123-metaiodobenzylguanidine (MIBG) scan also demonstrated abnormal focal activity. Result of preoperative adrenal function test was normal. A laparoscopic retrocaval tumor excision was performed successfully. The operative time was 160 minutes. The patient's postoperative recovery was uneventful and he was discharged on the fourth postoperative day. Pathologic examination was consistent with the diagnosis of paraganglioma. To the best of our knowledge, this is the first report on laparoscopic resection of a retrocaval non-functioning paraganglioma. In conclusion, laparoscopic retrocaval paraganglioma resection is safe and feasible.

Ureter retrocava: relato de caso / Retrocaval ureter: a case report

Relata-se o caso de um paciente com ureter retrocava, diagnosticado inicialmente em exame de urografia excretora e confirmado com tomografia computadorizada do abdome. A tomografia computadorizada torna-se necessária não apenas para confirmar a posição do ureter em relação à veiacava inferior, como também para excluir outras doenças que cursam com hidronefrose, pois hidronefrose é o principal achado do ureter retrocava sintomático.

The authors report a case of a patient with retrocaval ureter found out in an excretory urography and confirmed with abdominal computerized tomography. The computerized tomography is necessary to confirm the position of the ureter and to exclude other diseaseswhich are associated with hydronefrosis, the main imaging finding,when there is a symptomatic retrocaval ureter.

A Case of Multiple Urothelial Cell Carcinoma in Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compassed by inferior vena cava. We experienced a case of multiple urothelial cell carcinoma in retrocaval ureter in 68 years old male. He was treated with transurethral resection of bladder tumor and right nephroureterectomy with bladder cuff excision.

Nonobstructive Right Retrocaval Ureter Associated with Double Inferior Vena Cava / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly. We experienced a case of retrocaval ureter with double inferior vena cava and with intermittent right flank pain in 54 years old female. We performed IVU, RGP, Venacavogram, MRI, and diuretic DTPA renal scan. MRI is the best single study to delineate the anatomy clearly and noninvasively. She was treated with conservative treatment.

Retrocaval Ureter: A Clinical Review of 7 Cases / 대한비뇨기과학회지

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compressed by inferior vena cava. We present 7 cases of retrocaval ureter who admitted to our hospital from March 1984 to February 1994. Age of patients ranged from 23 to 65 years, a mean 37 years. The anomaly occurred 3 in male and 4 cases in female. Initial symptoms included flank pain in 5(71%) and symptom-free in 2 cases(29%). The patients were classified into type I(low loop, 5 cases) and type II(high loop, 2 cases) by Kenawi's classification depending on the level of uretero-caval cross over. Of 5 cases of type I retrocaval ureter 4 were underwent spatulated end-to-end ureteral anastomosis with resection of retrocaval ureteral segment, 1 was underwent nephrectomy. 2 cases of type II were treated conservatively. All of cases underwent spatulated end-to-end ureteral anastomosis showed regression of hydronephrosis and satisfactory drainage of the kidney in postoperative IVU. The pathologic findings of the resected ureteral segments showed fibrosis and chronic inflammatory cell infiltration in 3 and normal findings in 2 cases in H & E stain. But in the trichrome stain, fibrous replacement of ureteral muscle layers were demonstrated in all of cases. Guideline for treatment of retrocaval ureter may be based on specific radiographic criteria Resection of the retrocaval segment and spatulated end-to-end anastomosis may be required in the cases of the type I retrocaval ureter.

Two Cases of Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval ureter or circumcaval ureter is a congenital anomaly of vascular system commonly causing ureteric obstruction. We present a case of right retrocaval ureter with right renal stone in a 42 year old man and a case with right flank dull pain and hypertension in 40 year old female. They were treated with ureteral end to end anastomosis with double-J stent.

A Case of Retrocaval Ureter with Left Renal Agenesis / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly of the urogenital organ originating from the venous maldevelopment. To our knowledge, retrocaval ureter with contralateral renal agenesis has not been reported in Korea. Recently, we experienced a case of retrocaval ureter with contralateral renal agenesis, and obtained a good result following ureteral resection with end-to-end anastomosis of the ureter.

A Case of Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval or postcaval ureter is a well-recognized venous congenital anomaly commonly causing ureteric obstruction. A 42 year-old male was admitted to Korea University Hospital because of right flank pain. The right AGP reveals the S-shaped coures of ureter and hydronephrosis. The ureteral and to end anastomosis was done with double J ureteral stent. Herein we present a case of retrocaval ureter with brief review of literatures.

A Case of Retrocaval Ureter / 대한비뇨기과학회지

This rare venous congenital anomaly has been diagnosed preoperatively in a 35-year-old female with complaint of the right flank pain. Herein a case of retrocaval ureter is presented with brief review of literatures.

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Retrocaval Ureter: A Case Report / 대한비뇨기과학회지

Retrocaval ureter is a rare embryologic venous system anomaly of genitourinary tract and its essentially to the right side. We have reported diagnosed preoperatively in 41 years old male with complaints of intermittent right flank pain, with gross hematuria, urinary frequency, nocturia, tenesmus, and high fever. I.V.P. revealed delayed dye excretion on the right side with pyelocalyectasis and ureterectasis of upper ureter and stenotic portion beneath ureter was non visualization. R.G.P. revealed same as I.V.P. and right ureter was `sickle shape` course and its descent alonged over the right side of 4th and 5th lumbar vertebra column. On post operation 8th days, I.V.P. revealed slightly reduced of previous marked dilated right pelviocalyceal system with upper ureter and preoperative placed ureter was corrected to normal course.

Retrocaval Ureter: Report of Four Cases / 대한비뇨기과학회지

Clinical and radiographic findings of four patients with retrocaval ureter are presented. An IVP and a retrograde pyelogram usually delineate a retrocaval ureter and inferior venacavogram is helpful in a doubtful case. Division of the renal pelvis with transposition and renastomosis is a preferable from of treatment although segmental resection of the ureter with ruetero-ureteral anastomosis is indicated at times.