Contributed by Christine Dorvault, M.D., Shaila Fernandes, M.D. and Samuel Yousem, M.D.
Published on line in September 1996
CASE 1: This 45 year old man with a history of weightlifting and chronic back pain for twelve years, was evaluated for a complaint of three weeks of increased intensity of left flank pain. An intravenous pyelogram revealed a left retroperitoneal mass. MRI of the abdomen without contrast showed a 5.0 cm x 5.0 cm x 4.5 cm necrotic lesion extending inferiorly from the left renal hilum (T1 weighted coronal, T1 weighted axial, gradiant echo coronal). Serum alpha-fetoprotein, beta-human chorionic gonadotropin, and urine catecholamines were within normal limits. Excision of the retroperitoneal mass was performed.
CASE 2: This 42 year old woman with a history of persistent right lower quadrant pain with radiation to her back, hypertension, and migraine headaches was found on CT scan of the abdomen to have a retroperitoneal lesion. Serum catecholamines showed serum norepinephrine greater than 4,000 pg/ml (greater than 2,000pg/ml diagnostic of pheochromocytoma). 24 hour urine vanillyl mandelic acid was elevated at 36.1 mg (normal 2.0-7.0 mg/24 hours). Exploratory laparotomy showed a mass situated at the aortic bifurcation and a mass on the lesser curvature of the stomach. Resection of the retroperitoneal mass, two sacral/neural foramina lymph nodes, and wedge resection of the lesser curvature stomach to remove the small gastric mass was performed.