Retroperitoneal Soft Tissue Sarcoma

Kristin Janson Redmond and Deborah A. Frassica

 Background

What is the median age at Dx of retroperitoneal soft tissue sarcoma (STS)?

The median age at Dx of retroperitoneal STS is 65 yrs.

What % of STS are retroperitoneal?

10%–15% of STS are retroperitoneal.

What is the typical presentation of pts with retroperitoneal STS?

Pts with retroperitoneal STS typically present with vague abdominal complaints.

What is the median diameter of retroperitoneal STS at presentation?

The median diameter of retroperitoneal STS is 15 cm.

What % of retroperitoneal STS occur in the abdomen vs. the pelvis?

With regard to retroperitoneal STS, 70% occur in the abdomen and 30% in the pelvis.

What are the boundaries of the retroperitoneal space?

Boundaries of the retroperitoneal space:

1. 
   

   Superior: diaphragm

   
   
2. 
   

   Inferior: pelvic diaphragm

   
   
3. 
   

   Lateral: lat edge of quadratus lumborum, but lat edge of 12^th rib is also considered since it −corresponds to origin of transversus abdominus aponeurosis

   
   
4. 
   

   Anterior: parietal peritoneum

   
   
5. 
   

   Posterior: psoas, quadratus lumborum muscles in abdomen; iliacus, obturator internus, and pyriformis in pelvis

Which organs are retroperitoneal?

Retroperitoneal organs include the pancreas, kidneys, adrenal glands, and ureters.

What is the DDx of a retroperitoneal soft tissue mass?

The DDx of a retroperitoneal mass includes either malignant or benign tumors.

Malignant etiology includes:

1. 
   

   Sarcoma

   
   
2. 
   

   GI stromal tumor

   
   
3. 
   

   Lymphoma

   
   
4. 
   

   Germ cell tumor

Benign etiology includes:

1. 
   

   Desmoid tumor

   
   
2. 
   

   Lipoma

   
   
3. 
   

   Benign peripheral nerve sheath tumor (schwannoma, neurofibroma)

   
   
4. 
   

   Teratoma

   
   
5. 
   

   Paraganglioma

What are the 2 most common histologies of retroperitoneal sarcoma in adults?

The 2 most common histologies for retroperitoneal sarcoma in adults include liposarcoma and −leiomyosarcoma.

What is the most common histology of retroperitoneal sarcoma in children?

The most common histology of retroperitoneal −sarcoma in children is rhabdomyosarcoma.

 Workup/Staging

How does staging for retroperitoneal sarcoma differ from the general STS AJCC staging?

Staging for retroperitoneal STS is according to the AJCC staging for STS except the retroperitoneal location is always considered deep.

Do all pts with suspected retroperitoneal sarcoma require a preop Bx?

No.

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