DOI: 10.1148/rg.245045017
Retroperitoneal Cystic Masses: CT, Clinical, and Pathologic Findings and Literature Review1
Dal Mo Yang, MD,
Dong Hae Jung, MD,
Hana Kim, MD,
Jee Hee Kang, MD,
Sun Ho Kim, MD,
Ji Hye Kim, MD and
Hee Young Hwang, MD
1 From the Departments of Radiology (D.M.Y., H.K., J.H. Kang, S.H.K., J.H. Kim, H.Y.H.) and Pathology (D.H.J.), Gachon Medical School Gil Medical Center, 1198 Guwol-Dong, Namdong-Gu, Incheon 405-760, South Korea. Recipient of a Cum Laude award for an education exhibit at the 2003 RSNA scientific assembly. Received February 11, 2004; revision requested March 11 and received April 8; accepted April 12. All authors have no financial relationships to disclose. Address correspondence to D.M.Y. (e-mail: dmyang@ghil.com).
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Figure 1a. Retroperitoneal cystic lymphangioma in a 37-year-old man. (a) Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) shows variable-sized thin-walled cystic spaces in the stroma that are lined with endothelial cells and contain lymphoid aggregation. (b) Contrast material-enhanced CT scan shows a low-attenuation mass in the right anterior pararenal space (arrow).
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Figure 1b. Retroperitoneal cystic lymphangioma in a 37-year-old man. (a) Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) shows variable-sized thin-walled cystic spaces in the stroma that are lined with endothelial cells and contain lymphoid aggregation. (b) Contrast material-enhanced CT scan shows a low-attenuation mass in the right anterior pararenal space (arrow).
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Figure 2a. Retroperitoneal cystic lymphangioma in a 41-year-old man. Contrast-enhanced CT scans show a lobulated cystic mass (thick arrows) with tiny mural calcifications (thin arrow in b) in the anterior pararenal space. The third portion of the duodenum is compressed by the mass.
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Figure 2b. Retroperitoneal cystic lymphangioma in a 41-year-old man. Contrast-enhanced CT scans show a lobulated cystic mass (thick arrows) with tiny mural calcifications (thin arrow in b) in the anterior pararenal space. The third portion of the duodenum is compressed by the mass.
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Figure 3a. Retroperitoneal mucinous cystadenoma in a 41-year-old woman. (a) Contrast-enhanced CT scan shows a homogeneously hypoattenuating mass in the right anterior pararenal space (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows a single layer of mucin-containing tall columnar epithelial cells.
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Figure 3b. Retroperitoneal mucinous cystadenoma in a 41-year-old woman. (a) Contrast-enhanced CT scan shows a homogeneously hypoattenuating mass in the right anterior pararenal space (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows a single layer of mucin-containing tall columnar epithelial cells.
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Figure 4. Retroperitoneal mucinous cystadenoma in a 56-year-old woman. Contrast-enhanced CT scan shows a homogeneously hypoattenuating mass in the right retroperitoneal space (arrow). The ascending colon is displaced anteriorly. Note the dilatation of the left ureter, which is caused by a ureteral stone.
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Figure 5a. Cystic teratoma in a 3-year-old girl. (a) Contrast-enhanced CT scan shows a well-defined hypoattenuating mass with internal septa and calcifications in the right anterior pararenal space (arrow). (b) Photograph of the gross specimen shows the cyst wall as an irregular and protruding solid area. (c) Photomicrograph (original magnification, x40; H-E stain) demonstrates skinlike tissue.
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Figure 5b. Cystic teratoma in a 3-year-old girl. (a) Contrast-enhanced CT scan shows a well-defined hypoattenuating mass with internal septa and calcifications in the right anterior pararenal space (arrow). (b) Photograph of the gross specimen shows the cyst wall as an irregular and protruding solid area. (c) Photomicrograph (original magnification, x40; H-E stain) demonstrates skinlike tissue.
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Figure 5c. Cystic teratoma in a 3-year-old girl. (a) Contrast-enhanced CT scan shows a well-defined hypoattenuating mass with internal septa and calcifications in the right anterior pararenal space (arrow). (b) Photograph of the gross specimen shows the cyst wall as an irregular and protruding solid area. (c) Photomicrograph (original magnification, x40; H-E stain) demonstrates skinlike tissue.
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Figure 6a. Müllerian cyst in a 57-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined cystic mass in the left retroperitoneal space (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows the cyst lined by ciliated, cuboidal to low columnar epithelial cells resembling fallopian tube epithelium.
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Figure 6b. Müllerian cyst in a 57-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined cystic mass in the left retroperitoneal space (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows the cyst lined by ciliated, cuboidal to low columnar epithelial cells resembling fallopian tube epithelium.
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Figure 7a. Epidermoid cyst in a 30-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) shows fibrous tissue lined by stratified squamous epithelium that contains keratinous materials. (b) Contrast-enhanced CT scan shows a well-defined hypoattenuating mass in the pelvic retroperitoneum (thick arrow). The rectum is anteriorly displaced (thin arrow).
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Figure 7b. Epidermoid cyst in a 30-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) shows fibrous tissue lined by stratified squamous epithelium that contains keratinous materials. (b) Contrast-enhanced CT scan shows a well-defined hypoattenuating mass in the pelvic retroperitoneum (thick arrow). The rectum is anteriorly displaced (thin arrow).
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Figure 8a. Tailgut cyst in a 30-year-old woman. (a) Photomicrograph (original magnification, x40; H-E stain) shows a cyst wall lined with stratified squamous epithelium. (b) Contrast-enhanced CT scan shows well-defined, thin-walled multicystic masses in the presacral space (thin arrows). The rectum is compressed and anteriorly displaced (thick arrow).
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Figure 8b. Tailgut cyst in a 30-year-old woman. (a) Photomicrograph (original magnification, x40; H-E stain) shows a cyst wall lined with stratified squamous epithelium. (b) Contrast-enhanced CT scan shows well-defined, thin-walled multicystic masses in the presacral space (thin arrows). The rectum is compressed and anteriorly displaced (thick arrow).
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Figure 9a. Cystic change in paraganglioma in a 38-year-old woman with hypertension. (a) Contrast-enhanced CT scan shows a cystic mass with irregular walls in the right anterior pararenal space (arrow). (b) Photomicrograph (original magnification, x200; H-E stain) shows that the tumor consists of nests of monotonous round to polygonal cells with amorphous and granular cytoplasm and has a delicate capillary network.
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Figure 9b. Cystic change in paraganglioma in a 38-year-old woman with hypertension. (a) Contrast-enhanced CT scan shows a cystic mass with irregular walls in the right anterior pararenal space (arrow). (b) Photomicrograph (original magnification, x200; H-E stain) shows that the tumor consists of nests of monotonous round to polygonal cells with amorphous and granular cytoplasm and has a delicate capillary network.
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Figure 10. Cystic change in neurilemoma in a 50-year-old man. Contrast-enhanced CT scan shows a cystic mass in the pelvic retroperitoneum (arrow).
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Figure 11a. Cystic change in retroperitoneal leiomyosarcoma caused by chemotherapy in a 63-year-old woman. (a) Contrast-enhanced CT scan obtained before chemotherapy shows a large, lobulated soft-tissue mass with an attenuation value of 65 HU in the left anterior pararenal space (arrow). (b) On a contrast-enhanced CT scan obtained 6 months after chemotherapy, the mass (arrow) is hypoattenuating (20 HU) and decreased in size.
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Figure 11b. Cystic change in retroperitoneal leiomyosarcoma caused by chemotherapy in a 63-year-old woman. (a) Contrast-enhanced CT scan obtained before chemotherapy shows a large, lobulated soft-tissue mass with an attenuation value of 65 HU in the left anterior pararenal space (arrow). (b) On a contrast-enhanced CT scan obtained 6 months after chemotherapy, the mass (arrow) is hypoattenuating (20 HU) and decreased in size.
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Figure 12a. Pseudomyxoma retroperitonei resulting from rupture of a mucinous cystadenocarcinoma of the appendix in a 64-year-old man. Contrast-enhanced CT scans show lobulated hypoattenuating masses in the right lower quadrant (arrows in a, thick arrows in b), mass effect on the right psoas muscle and right ureter, and a tiny wall calcification (thin arrow in b).
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Figure 12b. Pseudomyxoma retroperitonei resulting from rupture of a mucinous cystadenocarcinoma of the appendix in a 64-year-old man. Contrast-enhanced CT scans show lobulated hypoattenuating masses in the right lower quadrant (arrows in a, thick arrows in b), mass effect on the right psoas muscle and right ureter, and a tiny wall calcification (thin arrow in b).
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Figure 13a. Perianal mucinous adenocarcinoma in a 79-year-old man with a 20-year history of anal fistula. (a) Contrast-enhanced CT scan shows large, lobulated cystic masses in the perianal region (arrows). These hypoattenuating lesions proved to contain mucin at surgery. (b) Photomicrograph (original magnification, x100; H-E stain) shows well-differentiated neoplastic glands associated with large lakes of mucin.
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Figure 13b. Perianal mucinous adenocarcinoma in a 79-year-old man with a 20-year history of anal fistula. (a) Contrast-enhanced CT scan shows large, lobulated cystic masses in the perianal region (arrows). These hypoattenuating lesions proved to contain mucin at surgery. (b) Photomicrograph (original magnification, x100; H-E stain) shows well-differentiated neoplastic glands associated with large lakes of mucin.
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Figure 14a. Pancreatic pseudocyst in a 49-year-old man with a history of chronic alcoholism. (a) Contrast-enhanced CT scan shows a thin-walled fluid collection in the anterior pararenal space (arrow). Percutaneous drainage of retroperitoneal fluid was performed, and 90 mL of dark yellowish fluid was removed. (b) Fluoroscopic image shows a cavity filled with contrast material, which had been injected through a catheter.
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Figure 14b. Pancreatic pseudocyst in a 49-year-old man with a history of chronic alcoholism. (a) Contrast-enhanced CT scan shows a thin-walled fluid collection in the anterior pararenal space (arrow). Percutaneous drainage of retroperitoneal fluid was performed, and 90 mL of dark yellowish fluid was removed. (b) Fluoroscopic image shows a cavity filled with contrast material, which had been injected through a catheter.
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Figure 15a. Nonpancreatic pseudocyst in a 53-year-old man. (a) Contrast-enhanced CT scan shows a well-defined cystic mass anterior to the right kidney (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows the cyst wall, which consists of connective tissue, along with severe chronic inflammation and hemorrhage. No cell lining is present.
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Figure 15b. Nonpancreatic pseudocyst in a 53-year-old man. (a) Contrast-enhanced CT scan shows a well-defined cystic mass anterior to the right kidney (arrow). (b) Photomicrograph (original magnification, x40; H-E stain) shows the cyst wall, which consists of connective tissue, along with severe chronic inflammation and hemorrhage. No cell lining is present.
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Figure 16. Lymphocele in a 51-year-old woman who presented with fever and low abdominal pain. The patient had undergone radical hysterectomy for cervical cancer 3 months earlier. Contrast-enhanced CT scan shows a hypoattenuating cystic mass located in the obturator space (arrows) and compressing the urinary bladder (B).
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Figure 17a. Urinoma in a 49-year-old woman who had undergone radical hysterectomy for cervical cancer. (a) Abdominal ultrasonographic image shows a well-defined cystic mass posterior to the urinary bladder (arrow and cursors). (b) Contrast-enhanced CT scan shows a large fluid collection with ring enhancement in the presacral space (arrow). The diagnosis was confirmed with CT-guided percutaneous aspiration and drainage.
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Figure 17b. Urinoma in a 49-year-old woman who had undergone radical hysterectomy for cervical cancer. (a) Abdominal ultrasonographic image shows a well-defined cystic mass posterior to the urinary bladder (arrow and cursors). (b) Contrast-enhanced CT scan shows a large fluid collection with ring enhancement in the presacral space (arrow). The diagnosis was confirmed with CT-guided percutaneous aspiration and drainage.
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Figure 18. Hematoma in a 51-year-old woman. Contrast-enhanced CT scan shows a huge cystic mass with thin walls in the right retroperitoneal space (arrow). Ultrasonography-guided percutaneous aspiration revealed flank hematoma.
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Copyright © 2004 by the Radiological Society of North America.
