[Diagnosis and treatment of primary retroperitoneal extra-organic tumors]. / Diagnoza i lechenie na p'rvichni retroperitonealni izv'norganni tumori.

Primary retroperitoneal extra-organ tumors (PRET) are a relatively rare group of diverse neoplasms. They are classified in three main groups according to their histogenesis: PRET from mesodermal origin, from ectodermal origin and from embryonic remnants. Most of PRET are malignant, a the most frequent malignant PRET are soft tissue sarcomas. Because of their specific localization PRETs grow silently for a relatively long period and are often considerably large at the time of diagnosis. These tumors usually have no specific symptoms. Computerized tomography and magnetic resonance imaging are the most useful methods in the diagnosis of PRET. Surgery is the only effective treatment of PRET with exclusion of some histologic types as lymphoma and malignant germ cell tumors. One of the most specific characters of PRET is their great tendency to recur locally, which is explained not only by their biological characteristics but the difficulties of accomplishing a radical resection. For the malignant PRET, especially the retroperitoneal soft tissue sarcomas, no adjuvant therapy has proved to be beneficial on survival.

[Ectopic splenic tissue mimicking a retroperitoneal tumor. A case report and literature review]. / Ektopichna lienala t'kan, imitirashta retroperitonealen tumor. Edin sluchai i pregled na literaturata.

Ectopic splenic tissue can be found as congenital or acquired condition. It is occasionally symptomatic and very rarely can simulate a neoplastic disease, especially when it locates in the retroperitoneal space. A case of ectopic splenic tissue simulating a retroperitoneal tumor is reported. A 32-years-old female was admitted in the clinic for a tumor in the left retroperitoneal space, discovered by ultrasound and computed tomography. 9 years before, an operation for a pheochromocytoma with similar localization was performed as the tumor was removed together with the spleen. At this admission, the tumor was considered a local recurrence of the pheochromocytoma and was resected. The result of the histopathological examination showed a splenic tissue.

[Diagnosis and surgical treatment of adrenocortical carcinoma. A review of the literature and report of two cases]. / Diagnoza i khirurgichno lechenie na adrenokortikalen kartsinom. Pregled na literaturata i predstaviane na dva klinichni sluchaia.

Adrenocortical carcinomas (ACC) are rare and represent only 0.05 to 0.2% of all cancers. They can be hormonally active, appearing clinically by one or more endocrine syndromes, or can be hormonally non-active. Commonly most of the cases with AC are diagnosed when the neoplastic process have spread out of the suprarenal gland (stage III or IV). Computed tomography and magnetic resonance imaging are the most useful diagnostic methods of ACC but the latter is more accurate, especially in estimation of the local invasion of the tumor. Surgery is the main and the most effective method for treatment of both primary and recurrent ACC, and in selective cases--of metastasis. The chemotherapy with mitotane has a limited role and is indicated in cases of inoperable ACC (primary or recurrent) and/or presence of metastasis. Two cases of ACC treated in our department are reported. Case I: a 26-years-old female with ACC in stage II, which was diagnosed incidentally by ultrasound investigation for other consideration. Although the urine levels of free cortisol were elevated, the woman had no endocrine symptoms. Case II: a 50-years-old female with a second recurrence ACC appeared 5 years after a resection of the first recurrence tumor and 6 years after an operation for the primary tumor. Problems in diagnose and surgical treatment of these cases are discussed.