case_images: PMC11024421_01
case_images: Preoperative imaging. (A) Computed tomography with intravenous contrast, transverse view, black arrow: an enhancing retroperitoneal mass, 4.1 cm in diameter, with clear boundaries, located in the left anterior pararenal space. (B) Computed tomography with intravenous contrast, transverse view, black arrow: an enhancing mass, 3.5 cm in diameter, located in the right retroperitoneal space. (C, D) Gallium-68 DOTATATE, transverse view, black arrows: a retroperitoneal mass, 3.5 cm in diameter, located medially to the upper pole of the right kidney, with increased uptake of the radioactive agent (SUVmax = 61), indicative of a neuroendocrine tumor.
case_images: fsurg-11-1323468-g001.jpg
case_images: PMC11024421_01_fsurg-11-1323468-g001.jpg
case_images: F1
case_images: A CT Scan revealed an enhancing retroperitoneal mass, 4.1 cm in diameter, with clear boundaries, located in the left anterior pararenal space, as illustrated in Figure 1A. However, another mass that was not described earlier appeared; 3.5 cm in diameter, located in the right retroperitoneal space (Figure 1B). 18F-fluoro-D-glucose (FDG) PET followed, which revealed an enlargement close to the pancreaticoduodenal groove with mild enhancement, with a Standardized Tyr3- octreotate) was performed afterward, reporting a retroperitoneal mass, 3.5 cm in diameter, located medially to the upper pole of the right kidney, close to inferior vena cava, with increased uptake of the radioactive agent (SUVmax = 61), indicative of a neuroendocrine tumor (Figures 1C,D). The patient was led to the operation theatre, where the tumor was identified in the ileac mesentery, as shown in Figures 2A,B, and entirely resected by laparoscopy (Figure 2C).
case_images: Intraoperative images from the second laparoscopy. (A) Black arrow: the mesenteric tumor arising from the ileac mesentery in close proximity to the duodenum. (B) Black arrow: the pancreatic head. (C) Completion of the laparoscopic excision of the tumor.
case_images: fsurg-11-1323468-g002.jpg
case_images: PMC11024421_01_fsurg-11-1323468-g002.jpg
case_images: F2
case_images: Tyr3- octreotate) was performed afterward, reporting a retroperitoneal mass, 3.5 cm in diameter, located medially to the upper pole of the right kidney, close to inferior vena cava, with increased uptake of the radioactive agent (SUVmax = 61), indicative of a neuroendocrine tumor (Figures 1C,D). The patient was led to the operation theatre, where the tumor was identified in the ileac mesentery, as shown in Figures 2A,B, and entirely resected by laparoscopy (Figure 2C).
case_images: Immunohistochemistry testing of the second tumor. (A) Hematoxylin eosin staining. (B) Chromogranin A staining positive. (C) CD56 staining positive. (D) Synaptophysin staining positive. (E) ki-67 index 10%.
case_images: fsurg-11-1323468-g003.jpg
case_images: PMC11024421_01_fsurg-11-1323468-g003.jpg
case_images: F3
case_images: Immunohistochemistry testing was positive for synaptophysin, chromogranin A, CKAE1/AE3, CD56, and ISLET-1, whereas it was negative for TTF-1, CK7, CK20, CDX2 and somatostatin (Figure 3).
case_images: Imaging before the first surgery where both tumors are apparent. (A) Computed Tomography with intravenous contrast, coronal view, (B) MRI, coronal view: white arrow indicating the 4.1 cm retroperitoneal mass located in the left anterior pararenal space, black arrow indicating the tumor located in the right retroperitoneal space.
case_images: fsurg-11-1323468-g004.jpg
case_images: PMC11024421_01_fsurg-11-1323468-g004.jpg
case_images: F4
case_images: Looking again carefully at the imaging before the first operation (Figure 4), it appeared that the second lesion was visible, although smaller in size, but it was not described either in the CT or in the MRI report.