Long-term survival after hand-assisted laparoscopic approach of primary retroperitoneal mucinous cystadenocarcinoma in male: case report and review of literature
A 59-year-old male experienced the sudden onset of left flank pain without radiation, which was dullness and persistent, but not alleviated by posture change. Physical examination did not disclose palpable intraabdominal mass and definite tender point. Results of the routine laboratory tests, chest X-ray, and tumor markers (CA-125 and carcinoembryonic antigen) were normal. Intravenous urography showed an 8 cm space-occupying lesion just below the left kidney, which displaced the left renal axis. Computed tomography (CT) revealed a well-capsulated tumor with heterogenous content and calcification in the left retroperitoneal space, which upwardly displaced the left kidney (Fig. ). Hand-assisted laparoscopic surgery was performed and the tumor was completely resected without rupture. The stomach, gallbladder, small intestines, appendix, colon, and omentum were explored and no suspicious lesions were disclosed. Grossly, the specimen was measured 7.5 ´ 7 ´ 3 cm and consisted of dark-brown viscid fluid within a thin-walled unilocular capsule. The outer surface was smooth and glistening, with some focal papillary tufting over the inner surface (Fig. ).\nMicroscopically, the capsule wall was covered by single or multiple layers of mucinous epithelium, with histological sequential distribution of benign, borderline malignant, and malignant cells. Obvious cytological atypia, foci of stromal invasion and lymphoid aggregates, and extensive calcification were also noted (Fig. ). PRMC with well differentiation was the final pathological diagnosis. The postoperative course was uneventful, and no evidence of recurrence was observed within a 79-months follow-up period.