Retroperitoneal Pathology Ch 16

Question 1

Adrenal cortical syndromes..

Answer 1

• Addison’s disease
• adrenogenital syndrome/adrenal virilism
• Conn’s syndrome (aldosteronism)
• Cushing’s syndrome
• Waterhouse-Friderishsen syndrome

Question 2

• affects males and females equally
• adrenocortical insufficiency
  
  • hyopfunction of adrenal gland**
  • atrophy of the adrenal cortex with decreased production of cortisol and sometimes aldosterone

Answer 2

Addison’s disease

Question 3

causes and examples of Addison’s disease

Answer 3

• autoimmue process
• tuberculosis (TB)
• inflammatory process
• primary neoplasm
• fungal infection (histoplasmosis)
• adrenal hemorrhage (anticoagulation therapy)
• bilateral mets

Question 4

• results in..
  
  • oversecreation of sex hormones and adrenal androgens (hirsutism)
  • congenital causes (impaired synthesis of cortical and aldostrone)
  • acquired causes (tumors)
• adrenals are symmetrically enlarged

Answer 4

adrenogenital syndromes

Question 5

-hyperaldosteronism
most commonly due to cortical adenoma
-adenomas are more common with females and tend to be small, less than 2cm
- hyperplasia is more common in males
-adrenal carcinoma is a less frequent cause

Answer 5

Conn’s Syndrome

Question 6

clinical symptoms of Conn’s syndrome

Answer 6

muscle weakness, hypertension, and abnormal electrocardiogram

Question 7

• hypercortisolism
• causes … adrenal hyperplasia, cortical adenoma, adrenal carcinoma, increase in ACTH-produced by pituitary gland(resulting from pituitary adenoma)

Answer 7

Cushing syndrome

Question 8

-truncal obesity, pencil thin extremities, “buffalo hump”, “moon face”, hypertension, renal stones, irregular menses and psychiatric disturbances

Answer 8

Cushing syndrome

Question 9

results from bilateral hemorrhage into the adrenal glands and caused by severe meningococcal infection

Answer 9

Waterhouse-Friderinchsen syndrome

Question 10

-uncommon, usually small and asymptomatic, females affected more than males, usually unilateral found incidentally, may become calcified

Answer 10

adrenal cysts**

Question 11

• in adult is usually caused by severe trauma or infection
• most common in the neonate, caused by the large size of the adrenals and high degree of vascularity
• sonographically varies depending upon the age of the hemorrhage

Answer 11

Adrenal hemorrhage

Question 12

• can account for hypersecretion of cortical hormones
• may be hyperfunctioning or non hyperfunctioning
• may cause cushing’s syndrome, Conn’s syndrome, or adrenogenital syndrome
• solid, well-defined, and round

Answer 12

Adrenal Adenomas

Question 13

-rare, highly malignant tumors with poor prognosis
may be hyperfunctional or nonfunctional
-difficult to differentiate from benign adenoma
larger, 3-6cm
-typically well-defined homogenous mass when small
-larger tends to have necrosis, hemorrhage or calcifications
-(rt) tumor may invade IVC and renal veins

Answer 13

Adrenal Malignant Tumors

Question 14

• commonly caused by primary lung, breast, stomach, colon, or kidney
• metastases to the adrenal gland typically cause adrenal insufficency
• differentiation of common benign adenoma is sometimes difficult when there is no other evidence of mets and the adreanl mass is unilateral

Answer 14

Adrenal Mets

Question 15

• orginate in the adrenal medulla
  
  • secretes epinephrine and norepinephrine in excessive amounts
  • these hormones produce hypertension
  • associated with severe headaches, tachycardia and palpitations, and excess perspiration

Answer 15

Pheochromocytoma

Question 16

associated with multiple endocrine neoplasm (MEN) and Von Hippel-Lindau disease

Answer 16

Pheochromocytoma

Question 17

• majority are benign
• usually unilateral, large bulky tumors with a variety of sonographic patterns
• ectopic adrenal pheochromocytomas are rare but may occur anywhere along the sympathetic nerve chain located parallel to the aorta

Answer 17

Phenochromocytoma

Question 18

• highly malignant tumors of the medulla
• most common tumor of infancy**
• most common malignancy of the adrenal glands in childhood**
• presents as an abdominal mass in childhood
• typically seen as an echogenic mass with poorly defined margins
• must be differentiated from Wilm’s tumor (nephroblastoma), and hepatobalstoma

Answer 18

Neuroblastoma

Question 19

• benign, nonfunctioning mas that contains both fat and bone marrow elements
• hyperechoic mass most commonly seen in the adrenal bed

Answer 19

retroperitoneal fat myelipoma

Question 20

• originates independently within the retroperitoneum
• most are malignant**
• types: lyphoma, leiomyoscarcoma, fibrosarcomas and rhabdomyosarcomas

Answer 20

primary retroperitoneal tumors

Question 21

-most common primary retroperitoneal tumor

Answer 21

lymphoma

Question 22

• complex sonographic pattern

- liposarcomas- highly reflective due to fat

Answer 22

leiomyosarcoma

Question 23

-may mimic lymphomas and extends across midline

Answer 23

fibrosarcomas and rhabdomyosarcomas

Question 24

-refers to enlargement of lymph nodes

Answer 24

lymphadenopathy

Question 25

neoplastic conditions assoc. with lymphadenopathy include

Answer 25

• lymphoma
• leukemia
• metastic disease

Question 26

one of the most common causes of lymphadenopathy

Answer 26

lymphoma, Hodgkin’s and non Hodgkin’s (much more massive, mesentery involvement more common)

Question 27

• may be seen as anechoic or hypoechoic masses in the para-aortic and paracaval regions
• appear sonolucent or hypoechoic because they are homogenous and have no significant interfaces

Answer 27

retroperitoneal lymphadenopathy

Question 28

enlarged nodes anterior and posterior to the mesenteric vessels represent the “sandwich sign”

Answer 28

retroperitoneal lymphadenopthay

Question 29

-enlarged lymph nodes surround mesenteric vessel(s)

Answer 29

sandwich sign

Question 30

• benign or malignant and the retroperitoneal space is the 4th most frequent site
  
  • ovaries testes, anterior mediastinum, retroperitoneum and sacrococcygeal region
• teratomatous tumors may arise within the upper retroperitoneum and the pelvis

Answer 30

Germ Cell tumors

Question 31

• may contain calcified echoes from bones, cartilage, teeth, and soft tissue elements
• teratomas are more common in childhood and are usually located in the upper pole of the left kidney (hetrogeneous and complex)

Answer 31

germ cell tumors

Question 32

• recurrent from previous resected tumors
• ex- renal cell CA
• ascites, retroperitoneal tumor
• liver should be evaluated for metastic involvement and para-aortic region for extension to the lymph nodes

Answer 32

secondary tumors

Question 33

retroperitoneal fluid collections

Answer 33

• urinoma
• hemorrhage
• abscess

Question 34

-a walled-off collection of extravasated urine that develops spontaneously after trauma, surgery, or a subacute or chronic urinary obstruction

Answer 34

urinoma

Question 35

-may occur in a variety of conditions, including trauma, vasculitis, bleeding, diathesis, leaking aortic aneurysm, or a bleeding neoplasm

Answer 35

hemorrhage

Question 36

-may result from surgery trauma, or perforations of the bowel or duodenum

Answer 36

abscess

Question 37

• a disease of unknown cause and may be associated with malignant process
• characterized by thick sheets of fiberous tissue in the retroperitoneal cavity
• hyopechoic midline mass**

Answer 37

retroperitoneal fibrosis Ormond’s disease