|Year : 2020 | Volume
| Issue : 1 | Page : 63-65
Primary retroperitoneal transitional cell carcinoma identified on 18F-fludeoxyglucose positron emission tomography/computed tomography: An exceedingly rare radio-pathological entity
Piyush Chandra1, Satish Nath1, Deepti Jain2
1 Department of Nuclear Medicine, MIOT International Hospital, Chennai, Tamil Nadu, India
2 Department of Pathology, MIOT International Hospital, Chennai, Tamil Nadu, India
|Date of Submission||17-Jul-2019|
|Date of Acceptance||14-Aug-2019|
|Date of Web Publication||31-Dec-2019|
Dr. Piyush Chandra
Department of Nuclear Medicine, MIOT International Hospital, Manapakkam, Chennai - 600 056, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
We report here initial staging and follow-up imaging findings of a case of primary retroperitoneal transitional cell carcinoma, one of the rarest nonurological tumors of the retroperitoneal space, to highlight the importance of18F-fludeoxyglucose positron emission tomography/computed tomography in this infrequently encountered pathology.
Keywords: Carcinoma, fludeoxyglucose, positron emission tomography/computed tomography, retroperitoneal, transitional cell
|How to cite this article:|
Chandra P, Nath S, Jain D. Primary retroperitoneal transitional cell carcinoma identified on 18F-fludeoxyglucose positron emission tomography/computed tomography: An exceedingly rare radio-pathological entity. Indian J Nucl Med 2020;35:63-5
|How to cite this URL:|
Chandra P, Nath S, Jain D. Primary retroperitoneal transitional cell carcinoma identified on 18F-fludeoxyglucose positron emission tomography/computed tomography: An exceedingly rare radio-pathological entity. Indian J Nucl Med [serial online] 2020 [cited 2020 Oct 1];35:63-5. Available from: http://www.ijnm.in/text.asp?2020/35/1/63/274356
A 65-year-old woman presented with right lower abdominal pain and right lower limb swelling.18 F-fludeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) was done for the evaluation of suspected malignant pelvic soft-tissue mass noted on ultrasonography.18 F-FDG PET/CT scan showed increased FDG uptake in the solid enhancing component of the large dumbbell-shaped solid-cystic mass in the right iliac fossa measuring 12 cm in the largest dimension with maximum standardized uptake value approximately 14.18, encasing the right iliac vessels [Figure 1]a, [Figure 1]b, [Figure 1]c, infiltrating the iliopsoas muscle with cystic component extending extra-abdominally into the right superficial groin [Figure 1]d and [Figure 1]e. There was evidence of mild right-sided hydro-uretero-nephrosis and no evidence of any significant locoregional lymphadenopathy or any distant metastasis. Ultrasound-guided biopsy from the metabolically active solid component revealed transitional cell carcinoma with focal squamous differentiation with cells showing strong membrane positivity for high molecular weight cytokeratin [Figure 2]a and [Figure 1]b. The patient was started on concurrent chemoradiotherapy (weekly 1 g intravenous Gemcitabine and image-guided radiotherapy - 55Gy in 25 fractions) and achieved complete metabolic and significant morphological regression of the tumor [Figure 3], white arrows] on follow-up18 F-FDG PET/CT scan done 6 months later.
|Figure 1: Staging whole-body fl udeoxyglucose positron emission tomography/computed tomography showing the presence of the metabolically active dumbbell-shaped solid-cystic mass (1a, 1 b and 1c- black arrows) in the right iliac fossa extending into groin (1d and 1e, white arrows) with no evidence of any distant metastasis elsewhere in the whole body|
Click here to view
|Figure 2: (a) H and E stain: High power view showing a fragment of the transitional cell-like epithelium with atypical mitotic activity (b) Cells showed strong membrane positivity for high molecular weight cytokeratin|
Click here to view
|Figure 3: Follow-up whole-body fludeoxyglucose positron emission tomography/computed tomography post chemoradiotherapy showing complete regression of the right iliac fossa lesion as seen on whole body MIP (3a), trans-axial CT and PET/CT images (3b and 3c- white arrows) with no evidence any new lesions elsewhere|
Click here to view
Primary retroperitoneal transitional cell carcinomas are rare malignant tumors of the retroperitoneal space. The tumors probably arise from the vestigial remnants of the urogenital ridge in the retroperitoneal space. The urogenital ridge which appears at around 5th week of gestation further gives rise to the gonadal ridge (further differentiates into ovary/testis), nephrogenic cord (further differentiate into kidneys), mesonephric duct (ureter, male genital ducts, and seminal vesicles), and paramesonephric ducts (uterine tubes). To the best of our knowledge, not more than five cases reported in literature.,,,, These tumors are usually large, cystic masses with enhancing solid components seen predominantly located in the iliac fossae without any communication with any visceral organ such as the ureter or bladder (common sites for transitional cell malignancies). A dumbell-shaped appearance of the tumor (similar to our case) with an extra-abdominal component extending into thigh through the psoas fascia has been reported previously. Clinically, these tumors usually present late with vascular invasion and complete surgical resection is rarely possible, resulting in poor overall survival.,, Similar to our case, complete tumor regression has been reported in one of the case reports after concurrent radiotherapy and chemotherapy, suggesting that probably this should be the preferred form of treatment for such tumors.
18 F-FDG PET/CT compared to diagnostic CT alone in this rare pathological entity can be advantageous. In one single scan, it can help ascertain the malignant nature of the solid-cystic mass, can help guiding biopsy from the most metabolically active area, can be helpful in staging for local/distant metastasis and can also be useful for assessing response to systemic/local treatments. PET/CT can also be useful for surveillance and early identification of disease recurrence as these tumors are generally very aggressive. The solid-cystic nature and intense FDG uptake noted on18 F-FDG PET/CT can also help differentiate it from other nonurological retroperitoneal pelvic soft-tissue tumors such as liposarcomas/leiomyosarcomas, which are usually low-moderately FDG avid tumors.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rey R, Josso N, Racine C. Sexual differentiation. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman J et al
., editors. Endotext. South Dartmouth (MA): MDText. Com, Inc.; 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279001/
. [Last updated 2016 Jun 12].
Sharma PK, Sinha RK, Mukherjee S. Primary retroperitoneal transitional cell carcinoma – A rare clinical entity. Urol J 2016;13:2869-70.
Basu S, Ansari M, Gupta S, Kumar A. Primary retroperitoneal transitional cell carcinoma presenting as a dumb-bell tumour. Singapore Med J 2009;50:e384-7.
Braasch JW, Mon AB. Primary retroperitoneal tumors. Surg Clin North Am 1967;47:663-78.
Gupta S, Gupta S, Sahni K. Retroperitoneal urogenital ridge transitional cell carcinoma. J Surg Oncol 1983;22:41-4.
Ichinohe K, Ijima M, Usami T, Baba S. Complete remission of primary retroperitoneal transitional cell carcinoma after radiotherapy and oral chemotherapy: A case report. Ann R Coll Surg Engl 2013;95:e52-4.
Macpherson RE, Pratap S, Tyrrell H, Khonsari M, Wilson S, Gibbons M, et al.
Retrospective audit of 957 consecutive 18F-FDG PET-CT scans compared to CT and MRI in 493 patients with different histological subtypes of bone and soft tissue sarcoma. Clin Sarcoma Res 2018;8:9.
[Figure 1], [Figure 2], [Figure 3]