Giant adrenal mass. Preoperative evaluation. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. There is a 1.9 cm simple cyst in the left lobe. No intrahepatic or extrahepatic biliary ductal dilatation. No suspicious enhancing lesion.SPLEEN: The spleen is displaced anteromedially into the midline. No focal suspicious lesion.PANCREAS: The pancreas is displaced medially. No focal lesion. No pancreatic duct dilatation.ADRENAL GLANDS: The left adrenal gland is compressed and displaced by the large retroperitoneal mass. There appears to be a fat plane between the adrenal gland and the mass. No adrenal mass is evident. The right adrenal gland is unremarkable.KIDNEYS, URETERS: The left kidney is displaced by the retroperitoneal mass. Multiple bilateral simple renal cysts. One cyst in the inferior pole of the left kidney has a rim of decreased signal and intermediate intrinsic T1 signal compatible with a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Within the left perirenal space posterior to the kidney there is a large mass which measures 24.1 x 13.0 x 19.3 cm. This mass is predominantly mildly increased T2 signal with with heterogeneous low signal internal components. There is prominent postcontrast enhancement of the peripheral components of the mass with areas of central hypoenhancement likely reflecting necrosis.Immediately adjacent to the main mass there are 2 additional nodules (series 2/2/2001 image 163 and image 147). It is unclear if these represent extensions of the main mass or small satellite lesions.The mass appears based within the retroperitoneal soft tissues and is not contiguous with or invading the adjacent organs.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Large retroperitoneal mass based in the left perirenal space is most compatible with a liposarcoma. There are 2 adjacent nodules which may reflect extension of the main mass or local metastases. No evidence of distant metastatic disease. There is extensive mass effect on the adjacent solid organs, but no evidence of direct invasion.