GRACE S.ROZYCKIMD, MBA
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.
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.
A. Left adrenal carcinoma
B. Intestinal lymphoma
C. Retroperitoneal extraskeletal Ewing sarcoma
D. Embryonic rabdomyosarcoma
Rosa F, Tortorelli AP, Papa V, Pacelli F, Doglietto GB. Image of the Month—Quiz Case. Arch Surg. 2008;143(5):511. doi:10.1001/archsurg.143.5.511