Das Aditi, Gahine Renuka, Patre Vivek, Hussain Nighat
Department of Pathology, Dr. B.R. Ambedkar Memorial Hospital, Pandit Jawaharlal Nehru Memorial Government Medical College, Raipur, India,
Department of Pathology, Dr. B.R. Ambedkar Memorial Hospital, Pandit Jawaharlal Nehru Memorial Government Medical College, Raipur, India.
Acta Cytol. 2019;63(3):189-197. doi: 10.1159/000497077. Epub 2019 Mar 20.
Retroperitoneal lesions present a great diagnostic challenge. Here we analyze the spectrum of retroperitoneal lesions and the utility of cytohistopathological correlation in early diagnosis.
This 7-year study was undertaken in 338 patients with a retroperitoneal mass (kidney/adrenal/ pancreas/retroperitoneal lymph node, or soft tissue origin). In a prospective analysis, 81 patients underwent image-guided fine-needle aspiration cytology (FNAC) and 70 of the 81 underwent Tru-cut biopsy/histopathological evaluation. Clinical, radiological, and pathological details of 257 patients were retrieved from institutional records for retrospective analysis. A total of 119 patients, i.e., 70 in the prospective analysis and 49 in the retrospective analysis, had cytohistopathological correlation.
Of the 338 cases, 88.4% were malignant (n = 274), 2.6% were benign (n = 8), 9% were nonneoplastic (n = 28), and 9% were inadequate (n = 28). Most were renal in origin (n = 106; 34.2%), followed by retroperitoneal soft tissue (n = 96; 31%). The most common nonneoplastic lesion was tubercular lymphadenitis (42.85%) and the most common benign lesion was paraganglioma (42.85%). The most common malignancy was renal cell carcinoma (21.16%), followed by Wilms' tumor (13.86%). In infancy and early childhood, Wilms' tumor, neuroblastoma, and germ cell tumor were the most common malignancies, while in middle age it was renal cell carcinoma, followed by pancreatic adenocarcinoma, and in the elderly age group it was metastatic carcinoma. Most malignancies were noted in the 5th to 6th decades. The overall sensitivity, specificity, and diagnostic accuracy of image-guided FNAC was 98.02, 72.22, and 94.12%, respectively.
Image-guided FNAC is highly sensitive and specific for early diagnosis of an otherwise silent retroperitoneal mass. It saves patient from meticulous surgical procedures for diagnostic reasons and allows more rational planning of management. Knowledge of the distribution of tumors by age group helps to narrow down differential diagnoses.
腹膜后病变的诊断极具挑战性。在此,我们分析腹膜后病变的范围以及细胞组织病理学相关性在早期诊断中的作用。
本项为期7年的研究纳入了338例患有腹膜后肿块(源于肾脏/肾上腺/胰腺/腹膜后淋巴结或软组织)的患者。在前瞻性分析中,81例患者接受了影像引导下细针穿刺抽吸细胞学检查(FNAC),其中81例中的70例接受了切割活检/组织病理学评估。从机构记录中检索了257例患者的临床、放射学和病理学详细信息用于回顾性分析。共有119例患者,即前瞻性分析中的70例和回顾性分析中的49例,进行了细胞组织病理学相关性分析。
在338例病例中,88.4%为恶性(n = 274),2.6%为良性(n = 8),9%为非肿瘤性(n = 28),9%为不充分(n = 28)。大多数起源于肾脏(n = 106;34.2%),其次是腹膜后软组织(n = 96;31%)。最常见的非肿瘤性病变是结核性淋巴结炎(42.85%),最常见的良性病变是副神经节瘤(42.85%)。最常见的恶性肿瘤是肾细胞癌(21.16%),其次是肾母细胞瘤(13.86%)。在婴儿期和儿童早期,肾母细胞瘤、神经母细胞瘤和生殖细胞肿瘤是最常见的恶性肿瘤,而在中年,是肾细胞癌,其次是胰腺腺癌,在老年组是转移性癌。大多数恶性肿瘤见于第5至6个十年。影像引导下FNAC的总体敏感性、特异性和诊断准确性分别为98.02%、72.22%和94.12%。
影像引导下FNAC对原本无症状的腹膜后肿块的早期诊断具有高度敏感性和特异性。它使患者免于因诊断原因进行细致的外科手术,并有助于更合理地规划治疗方案。了解各年龄组肿瘤的分布有助于缩小鉴别诊断范围。