Rampersad Fidel, Diljohn Jason, Teelucksingh Surujpal, Greaves Wesley, Dan Dilip
Radiology Unit, Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad, West Indies.
The University of the West Indies, St Augustine Campus, Trinidad, West Indies.
Radiol Case Rep. 2021 Apr 15;16(6):1493-1498. doi: 10.1016/j.radcr.2021.03.033. eCollection 2021 Jun.
Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.
腹膜后脂肪肉瘤是罕见的间充质肿瘤，由于其出现较晚，预后较差。当出现症状时，通常是非特异性的，与肿块效应或局部结构侵犯有关。腹膜后脂肪肉瘤很少能在临床和生化方面模拟嗜铬细胞瘤。我们讨论这样一例病例，一名56岁的非洲裔特立尼达女性，因3个月的虚弱、间歇性出汗、睡眠困难和血压升高症状就诊于她的初级保健医生。在进行了为期2周的口服抗高血压治疗试验后，她的血压仍然升高，并且她抱怨出现了新的右侧腹痛。随后对她的腹部进行计算机断层扫描显示，右侧肾上腺有一个增强的、不均匀的肿块，怀疑是嗜铬细胞瘤。尿儿茶酚胺也升高，腹部MRI支持嗜铬细胞瘤的诊断，尽管在瘤内发现了脂肪，这是嗜铬细胞瘤不常见的特征。她被安排进行腹腔镜肾上腺切除术。对切除标本的组织学分析证实为去分化型腹膜后脂肪肉瘤。虽然嗜铬细胞瘤和腹膜后脂肪肉瘤的影像学特征可能相似，但CT和MRI上瘤内脂肪的存在应支持腹膜后脂肪肉瘤的诊断，尽管有临床和生化表现。
