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OpenAthens Shibboleth
Special Feature
May 01, 2008

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Digestive Surgery Unit, Department of Surgical Sciences, Catholic University School of Medicine, Rome, Italy.




Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Surg. 2008;143(5):511. doi:10.1001/archsurg.143.5.511

A 31-year-old man presented with lumbar–left flank pain and sporadic microhematuria. On hospital admission, a physical examination revealed a huge abdominal mass in the left hypochondrium, apparently fixed in the deep planes. Laboratory investigations revealed a hemoglobin level of 12.2 g/dL (to convert to g/L, multiply by 10.0) and a platelet count of 290/μL (the conversion from value/μL to value × 109/L is a 1-to-1 conversion); serum levels of tumor markers were within normal limits. Observation of the abdomen by computed tomography (Figure 1) showed a 12.6 × 9.3-cm lesion with central necrosis that occupied almost the entire left hypochondrium and flank, involved the psoas muscle, the spleen, the pancreatic tail, and the celiac artery, infiltrated the left renal parenchyma and vascular structures, and displaced the descending colon inferiorly.

Figure 1.
Image not available

Abdominal computed tomographic scan showing a 12.6 × 9.3-cm mass with central necrosis occupying almost the entire left hypochondrium and flank. L indicates left; R, right.

Findings from an ultrasonographic examination confirmed the voluminous mass and revealed left hydronephrosis.

What Is the Diagnosis?

A. Left adrenal carcinoma

B. Intestinal lymphoma

C. Retroperitoneal extraskeletal Ewing sarcoma

D. Embryonic rabdomyosarcoma