Retroperitoneal Tumors: Diagnosis and Management Insights

Retroperitoneal tumor

Hello! In early October, during a physical examination, an abdominal ultrasound revealed left hydronephrosis.
I was hospitalized in the urology department for an intravenous pyelogram (IVP), abdominal CT, and MRI (all with contrast injection), as well as ureteroscopy and retrograde pyelography.
Blood tests were conducted, and it was determined that there was an external mass compressing the ureter (the ureter has been stented).
A CT-guided biopsy of the external mass was performed, which did not reveal any cancer cells, and there were also no immunoglobulins found after staining.
Blood tests showed slightly elevated levels of ESR and HCG (ESR: 23, HCG: 11).
Consultations with gynecology and rheumatology were conducted, and gynecology reported no issues.
The attending urologist is treating it as an inflammatory condition (prescribing anti-inflammatory medication).
At the follow-up in early December, ESR was 20, and HCG was not tested.
A CT evaluation is planned for January.
I would like to ask: 1.
Can MRI determine whether a mass is benign, malignant, or inflammatory? 2.
What is the error rate for CT-guided biopsies? 3.
Is there a need to seek further treatment? I would like to add that I currently have no discomfort and my appetite is normal.

Hsiuli, 60~69 year old female. Ask Date: 2018/12/24

Dr. Lai Yicheng reply Oncology

1.
Can MRI determine whether a lesion is benign, malignant, or inflammatory? Answer: No, MRI cannot determine this.
The indications for MRI include: head, cerebrovascular conditions, various spinal nerve disorders, tumors, abdominal, liver, spleen, pancreas, kidney lesions, pelvic, uterus, ovaries, prostate, lymph nodes, heart, cardiovascular issues, ligament disorders, angiography, and musculoskeletal system.
If a suspicious lesion is found after an MRI examination, further confirmation with a CT scan is required.
2.
What is the error rate for CT-guided biopsies? The advantage of this examination is that it can obtain sufficient tissue samples with high accuracy in localization while minimizing potential postoperative complications.
The success rate for obtaining adequate tissue samples is approximately 69% to 93%.
The main reason for failure to obtain sufficient tissue samples is that the lesion is too small, particularly if it is less than 1 centimeter.
3.
Is further intervention needed? It is advisable to discuss your concerns with your attending physician or consult other doctors.
Regular follow-up examinations are essential.
Thank you for your concern.
Department of Radiation Oncology, Changhua Hospital, Dr.
Lai.

Reply Date: 2018/12/24

More Info

Understanding retroperitoneal tumors involves a comprehensive approach to diagnosis and management, particularly when faced with complex cases like the one you've described. Retroperitoneal tumors can arise from various tissues, including fat, lymphatic tissue, and connective tissue, and can be benign or malignant. The management of these tumors often requires a multidisciplinary approach, involving urologists, oncologists, radiologists, and pathologists.

1. MRI and Its Role in Diagnosis
Magnetic Resonance Imaging (MRI) is a valuable tool in the evaluation of retroperitoneal tumors. However, it is important to note that while MRI can provide detailed images of soft tissue structures, it cannot definitively determine whether a tumor is benign or malignant. MRI is particularly useful for assessing the extent of the tumor, its relationship to surrounding structures, and for identifying any potential invasion into adjacent organs. In your case, if the MRI shows a mass that is compressing the ureter, it may suggest a significant lesion, but further diagnostic steps are necessary to ascertain its nature.

2. CT-guided Biopsy and Its Accuracy
CT-guided biopsy is a common procedure used to obtain tissue samples from suspicious masses. The success rate of obtaining adequate tissue for diagnosis typically ranges from 69% to 93%, depending on factors such as the size and location of the tumor. Smaller lesions, particularly those less than 1 cm, may pose a challenge for accurate sampling. In your situation, since the biopsy did not reveal cancer cells, it suggests that the mass may be benign, but it does not completely rule out malignancy. Continuous monitoring and follow-up imaging are essential to ensure that any changes in the mass are promptly addressed.

3. Further Management and Follow-Up
Given that your current symptoms are minimal and you are in good general health, the approach of monitoring the situation with follow-up imaging is reasonable. The elevated ESR (Erythrocyte Sedimentation Rate) and HCG (Human Chorionic Gonadotropin) levels may indicate some underlying inflammatory process, but they are not definitive for malignancy. The fact that gynecological and rheumatological consultations did not reveal any issues is reassuring.

It is crucial to maintain open communication with your healthcare team. If there are any changes in your symptoms or if you develop new symptoms, such as pain or changes in urinary habits, you should report these immediately. Regular follow-up appointments and imaging studies, as recommended by your urologist, will help in monitoring the situation.

Conclusion
In summary, the management of retroperitoneal tumors requires careful evaluation and a tailored approach based on individual circumstances. MRI is useful for assessing the tumor's characteristics, but it cannot definitively diagnose its nature. CT-guided biopsy is a reliable method for obtaining tissue samples, although it has its limitations. Continuous monitoring and follow-up are essential, especially in the absence of significant symptoms. Always consult with your healthcare provider regarding any concerns or changes in your condition, and ensure that you adhere to the recommended follow-up schedule for imaging and evaluations.

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