Related Experiment Videos
Metastasis--an unusual cause of retroperitoneal fibrosis
Anup Sadhu1, Santanu Sen, S Seal
1Eko CT and MRI Scan Centre, Medical College, Kolkata.
Abstract:
Retroperitoneal fibrosis is one of the rare fibrotic processes mainly involving caudal aspect of the retroperitoneum. In up to 70% of patients no causative factor for retroperitoneal fibrosis can be identified, where it resembles auto-immune reaction. A 30-year-old lady presented with progressive oedema of the lower extremities, jaundice and abdominal swelling. Clinical examination revealed doughy abdominal feel and diffuse tenderness. Ultrasonography showed dilated intrahepatic bilary radicles and mild ascites. Contrast CT-scan showed enhancing sheath of soft tissue extending from porta down to aortic bifurcation encasing common bile duct, aorta, inferior vena cava and the ureters. CT-guided fine needle aspiration cytology revealed metastatic adenocarcinoma. Ascitic fluid did not show any malignant cell. No abdominal mass could be detected. The patient died during the course of palliative chemotherapy.
Insights
Retroperitoneal fibrosis, a rare condition, can be caused by metastatic adenocarcinoma. This case highlights a young woman with unexplained symptoms, ultimately diagnosed with advanced cancer.
Area of Science:
- Oncology
- Gastroenterology
- Radiology
Background:
- Retroperitoneal fibrosis (RPF) is a rare fibrotic condition affecting the retroperitoneum.
- Idiopathic RPF, resembling autoimmune reactions, accounts for up to 70% of cases.
- Malignant causes of RPF are less common but critical to diagnose.
Observation:
- A 30-year-old female presented with lower extremity edema, jaundice, and abdominal swelling.
- Clinical findings included a doughy abdomen and diffuse tenderness.
- Imaging revealed a soft tissue sheath encasing major abdominal structures.
Findings:
- Contrast CT-scan demonstrated an enhancing soft tissue sheath encasing the common bile duct, aorta, inferior vena cava, and ureters.
- CT-guided fine needle aspiration cytology confirmed metastatic adenocarcinoma.
- Ascitic fluid analysis was negative for malignant cells, and no primary abdominal mass was detected.
Implications:
- This case underscores the importance of considering malignancy in the differential diagnosis of retroperitoneal fibrosis, even in young patients.
- Metastatic adenocarcinoma can present insidiously with retroperitoneal involvement, mimicking idiopathic RPF.
- Timely diagnosis and palliative chemotherapy are crucial for managing such advanced cases, despite a poor prognosis.
Related Concept Videos
02:30Metastasis
Epithelial-to-Mesenchymal Transition
The epithelial-to-mesenchymal transition or EMT is a developmental process commonly observed in wound healing, embryogenesis, and cancer metastasis. EMT is induced by transforming growth factor-beta (TGF-β) or receptor tyrosine kinase (RTK) ligands, which further...
01:24Cirrhosis II: Pathophysiology