Karkos Christos D, Pepis Panagiotis D, Theologou Marios, Ballas Konstantinos, Petras Panagiotis, Arapoglou Stergios, Giagtzidis Ioakeim T, Mitka Maria, Pliatsios Ioannis, Papazoglou Konstantinos O, Kambaroudis Apostolos G
5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece.
5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece.
Ann Vasc Surg. 2019 Apr;56:354.e21-354.e23. doi: 10.1016/j.avsg.2018.08.103. Epub 2018 Nov 26.
We present a unique case scenario of a periaortic liposarcoma masquerading as an impending rupture of an inflammatory abdominal aortic aneurysm (AAA).
A 57-year-old man was referred to our unit for an emergency endovascular repair of "an inflammatory AAA with computed tomography (CT) features of impending rupture." He underwent an uneventful endovascular repair with a bifurcated endograft (C3; Gore, Flagstaff, AZ). Seven weeks later, CT showed that the periaortic "mass" grew larger and asymmetric, and a CT-guided needle biopsy suggested the presence of a high-grade malignant mesenchymal tumor. He underwent laparotomy and excision of the retroperitoneal tumor en bloc with the anterior wall of the infrarenal aorta. The endograft acted as an excellent "safety net" providing adequate hemostatic control and obviating the need for aortic cross-clamping and repair of the aortic defect with a patch or tube graft.
The learning point from the present case is that when faced with an inflammatory AAA and/or retroperitoneal fibrosis, the rare possibility of a retroperitoneal neoplasm should be kept in mind.
我们呈现了一个独特的病例，腹主动脉周围脂肪肉瘤伪装成炎性腹主动脉瘤（AAA）即将破裂的情况。
一名57岁男性因“具有计算机断层扫描（CT）显示即将破裂特征的炎性AAA”被转诊至我院进行紧急血管内修复。他接受了使用分叉型血管内移植物（C3；戈尔公司，弗拉格斯塔夫，亚利桑那州）的顺利血管内修复。七周后，CT显示腹主动脉周围“肿块”增大且不对称，CT引导下穿刺活检提示存在高级别恶性间叶性肿瘤。他接受了剖腹手术，将腹膜后肿瘤与肾下腹主动脉前壁整块切除。血管内移植物起到了出色的“安全网”作用，提供了充分的止血控制，避免了主动脉交叉钳夹以及用补片或管状移植物修复主动脉缺损的需要。
本病例的经验教训是，当面对炎性AAA和/或腹膜后纤维化时，应牢记腹膜后肿瘤这一罕见可能性。
