retroperitoneal lipoma
Introduction
Introduction to retroperitoneal lipoma Retroperitoneal lipoma is also known as primary retroperitoneal lipoma, renal or primary retroperitoneal abdominal extra-organic lipoma, that is, lipoma that does not include substantial organs such as kidney, adrenal gland, and pancreas. basic knowledge The proportion of illness: 0.01% - 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: bloating
Cause
The cause of retroperitoneal lipoma
(1) Causes of the disease
The cause of this disease is still unknown.
(two) pathogenesis
Retroperitoneal lipoma is a benign tumor of localized adipose tissue hyperplasia in the retroperitoneal space. It has an oblate lobulated shape, a capsule, a soft texture, a pale yellow cut surface, and a tumor size ranging from a few centimeters to a large head. Or larger, often single or multiple, the structure under the microscope is the same as that of normal adipose tissue. The main difference is that there is an envelope, the size of the tumor is irregular, and there are unequal fibrous tissue intervals. The body grows slowly.
Prevention
Retroperitoneal lipoma prevention
Early detection should be early, to prevent complications.
Complication
Retroperitoneal lipoma complications Complications
1. Compression of adjacent organs can cause obstruction of the hollow organs.
2. If the nerve is compressed, it will show the back of the back, the pain of the perineum and lower limbs, and the loss of consciousness and numbness in the innervation area.
Symptom
Retroperitoneal lipoma symptoms Common symptoms Swelling nausea and bloating
The clinical manifestations are uncharacteristic, often asymptomatic in the early stage, and the tumor grows to a considerable extent before symptoms appear. The main manifestations are:
1. Occupy symptoms The tumor grows enormously, and the patient feels bloating, which can affect the breathing. When growing in the pelvic cavity, there may be a feeling of bulging.
2. Severe symptoms caused by compression of adjacent organs can cause obstruction of the hollow organs. Gastrointestinal symptoms are nausea, vomiting, rectal stimulation can increase the frequency of bowel movements, urgency and weight, feeling of falling, urinary symptoms have frequent urination, urgency, There may be hematuria, dysuria, hydronephrosis, and even uremia, pain symptoms, such as compression of the nerves, the back of the lower back, perineal and lower limb pain, there may also be related to nerve damage, numbness and other numbness.
3. The abdomen can touch the mass, accounting for more than 95%.
Examine
Examination of retroperitoneal lipoma
1. Digestive tract barium meal and barium enema can exclude digestive tract tumors. When the tumor is large enough, the gastrointestinal tract can be displaced or distorted. The mass is located in the lower abdomen, and the small intestine can be displaced upward or sideways. In the upper abdomen, the small intestine and the transverse colon are moved down. The detection rate of this test is below 50%.
2. Intravenous pyelography and retrograde pyelography mostly have renal pelvis, ureter, bladder displacement, compression, the rate of discovery is 66%.
3. B-ultrasound can identify the tumor location, size, number, and the relationship with the surrounding organs, to understand whether the tumor is solid or cystic, the discovery rate is 80%.
4. CT accuracy is higher than B-ultrasound, the discovery rate is 89%. The location, size, range of tumors, and the relationship with adjacent organs are more intuitive and clear. Enhanced scanning can show the relationship between tumor and peripheral blood vessels. The appearance of fat density is characteristic (Figure 1).
5. Magnetic resonance is superior to CT in finding the extent of tumor and its relationship with surrounding tissues and blood vessels.
6. Selective angiography can be displaced, and it is meaningful for the location of retroperitoneal tumors and understanding the blood supply of the tumor, but it is not specific.
Diagnosis
Diagnosis and differentiation of retroperitoneal lipoma
Diagnostic criteria
B-ultrasound or CT-guided fine needle aspiration biopsy can often be characterized, and combined with immunological methods for the specific diagnosis of tumor cell tissue source and cell surface markers, can be diagnosed.
1. Clinical manifestations.
2. Other auxiliary inspections.
Differential diagnosis
The disease should be identified primarily with the following diseases:
1. A lump from the abdominal cavity
(1) The masses of benign and malignant tumors of the gastrointestinal tract are relatively small and limited, mainly due to filling defects in the lumen and stiffness of the wall, and the lumen is narrow.
(2) Most of the hepatomegaly caused the small curvature of the stomach and the duodenal bulb to shift to the left and the back, and the spleen of the colon moved down.
(3) When the splenomegaly is large, the fundus and the large curved side are displaced to the lower right or the lower side, which is easy to reach. The spleen or mass behind the fundus is feasible for gastric wall angiography, which is not difficult to identify.
(4) Female genital masses have more pressure on the pelvic cavity, and the small intestine moves up. When combined with gynecological examination, it is still difficult to determine pelvic inflation.
2. Tumors from the retroperitoneal organs
(1) Pancreas, kidney, adrenal tumor, venous pyelography, CT, magnetic resonance, B-ultrasound and other tests can determine its location.
(2) tuberculous psoas abscess is accompanied by adjacent vertebrae to destroy the abscess and still have calcification.
(3) Abdominal aortic angiography of giant abdominal aortic aneurysm showed tumor-like dilatation.
3. Primary retroperitoneal benign and malignant tumors
(1) Benign tumors can be differentiated by density, signal, and echo of various tissues by CT, MRI, and B-ultrasound.
(2) malignant tumors can be combined with clinical symptoms, signs and tumors and surrounding tissue boundaries are clear or not, whether there is infiltration, lymph nodes with or without swelling can be identified, if necessary, B-ultrasound or CT guided biopsy qualitative, where The identification of liposarcoma is difficult, but the fat sarcoma CT is a fat mass with uneven density, the lesion is more extensive, and the capsule is more incomplete; while the lipoma has uniform density and intact capsule.
