38-year-old male with recurrent retroperitoneal sarcoma and abdominal pain. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Previously seen fluid density medial to the left adrenal gland demonstrates heterogeneous enhancement and is compatible with tumor.KIDNEYS, URETERS: Distortion of the left kidney with hydronephrosis due to extensive left retroperitoneal tumor, similar to prior exam (see below).RETROPERITONEUM, LYMPH NODES: Extensive left retroperitoneal heterogeneous tumor has increased in size since prior study. The largest, central solid component of the mass measures up to 18.5 x 14.6 cm in greatest axial dimension at the level of the aortic bifurcation (series 2101/39), previously 13 x 9.7 cm. Central hypoenhancement of the solid component is most likely due to tumor necrosis. Tumor crosses the midline in the abdomen.Surrounding rim-enhancing, cystic lesions have increased in number and size significantly, with the largest centered in the mid abdomen and measuring up to 10.9 x 12.9 cm (series 2101/98), most compatible with increased tumor. Enhancing tumor is seen medial to the left adrenal gland, where there is mild invasion into the left medial diaphragmatic crus. Tumor extends posterior to the left kidney and inferiorly to the level of the mid left external iliac artery. Tumor distorts and invades into the mid to inferior pole of the left kidney, which is inseparable from the largest solid component. Tumor invades into the pancreatic tail and lesser sac. There is compression of the underlying iliopsoas muscle, which is inseparable from the tumor over a large extent. The aorta, IVC, and SMA are deviated to the right by the tumor. Tumor encases the left renal artery near the hilum, abuts the left common iliac artery, and encases the left external iliac artery.BOWEL, MESENTERY: Extrinsic displacement and compression of bowel by the retroperitoneal mass, including the second portion of the duodenum. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Extensive left retroperitoneal tumor has significantly increased in size, as detailed above.