A 69-year-old male presented to us for revision of pro-blocking syndrome treated with alpha-blockers.
She had a history of right hip surgery, hearing loss and repeated angina.
Episode of left costolumbar trauma about 30 years ago.
Hematuria on two occasions, the last time a year ago, was a urological history.
The prostatic examination showed fibroadenomatous features, volume II/IV, with no nodules.
Abdominal palpation revealed a large mass in the hypochondrium and left empty spaces, painful to constipation.
Analytical: Hb 14.6 gr/dl, hematocrit.
43.1%, VSG 9 mm/h and biochemistry normal.
PSA: 3.1 ng/ml.
Simple X-ray: great mass effect located in the hypochondrium and left empty, in a totally calcified ovoid form.
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These findings raise differential diagnosis with any mass located in the retroperitoneum that presents this type of classification:
- Retroperitoneal colitis
- Adrenal tumors
- Kidney tumors
- Metastatic tumors
- Infectious disease
Blood determinations of plasma renin activity were performed before and after ambulation, as well as aldosterone and cortisol at 8 and 20 hours, the results being within normal limits.
Urine levels of 17-ketosteroids and corticosteroids, as well as cathodes, metanephrines and vanillmandelate were normal.
All this ruled out functioning adrenal tumor.
Staining for acid-fast bacilli in urine and sputum was negative, as well as the Mantoux test.
The possibility of calcified hydatid cyst was raised, but serology was negative.
Likewise, left costolumbar trauma, previously suffered, was thought to be a possible cause of calcified adrenal mass.
With the diagnosis of retroperitoneal mass without filiation practi laparatomy exploited because of an overlying fat lesion in the left hypochondrium, the same intraoperatory malignant mesoscopic report of a probable intra-peritoneal tumor was harshapearted, with fixation to diffuse lesions.
Abdominal cavity closure was decided because it was a disseminated malignant process.
The definitive pathological report is pleomorphic liposarcoma. Immunohistochemical techniques are: S100: positive; Oil-Red: positive; vimentin: positive; PS 3: positive; desmin: negative:
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The patient was discharged on the seventh day after the intervention and died two weeks later at home.
