A 66-year-old man from the Gastroenterology Department complained of a 25 cm retroperitoneal mass on abdominal ultrasound examination for dyspepsia.
His personal history included old pulmonary tuberculosis and chronic obstructive pulmonary disease.
Physical examination revealed a large mass deforming the right anterior hemiabdomen, extending from the subcostal area to the pubis.
The location was painless, firm, with no signs of peritoneal irritation and percussion hue.
A rectal examination revealed a well-defined adenomatous, size II/V prostate.
Blood analysis, sediment and urine culture were normal, and PSA value was 1.2 ng/ml.
Abdominal ultrasound showed a cystic lesion of 25 cm in diameter, with abundant internal echoes, extending from the lower edge of the liver to the groin.
In i.v. urography.
(IUV) distortion of the right renal silhouette and pelvis was observed, with significant displacement of the lumbo-iliac segment of the right ureter, surpassing the ipsilateral upper urinary tract as well as the abdominal midline.
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The CT scan revealed a right retroperitoneal mass, 25 cm in diameter and cystic in the posterior colon extending from the pituitary region.
Cystic wall punctiform calcifications were also observed.
The medial and inferior portion of this mass showed a tubular structure of 2 cm in diameter and 7 cm in length, with progressive tapering in caudal direction, ending in complete stop.
The right kidney was functionally normal.
The CT findings were interpreted as a possible dysplastic right lower hemi-rain with partial agenesis of the ureter.
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Because of the diagnostic doubts existing with diagnostic tests performed, it was decided to perform a percutaneous biopsy, which was reported as a cystic lesion wall, and urine cytology, which did not show malignant cells.
Later, surgical intervention was performed through right pararectal approach, observing a cystic mass related in its cranial end with the right hepatic lobe and the inferior pole of the kidney, and in its caudal end with the internal inguinal orifice and Retzius.
No intra-abdominal organ damage was observed.
Careful resection of cystic mass and cecal appendix was performed, which was closely related to its caudal portion.
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The pathological study of the specimen showed a dilated appendix, lined by cytologically mucinous epithelium, forming papillary structures.
These findings were diagnostic of mucinous cystadenoma of the appendix.
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The postoperative course was normal.
In the VUI performed three months after surgery, good bilateral renal function was observed, with lateral hypercorrection of the right ureteral tract and disappearance of the right renal distortion.
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In the review performed at 20 months, the patient is asymptomatic from the urological point of view, and in the control TAC there is no evidence of abdominal lesions suggestive of pseudomyxoma peritonei.
