The patient underwent a left radical nephrectomy and periaortic
lymph node dissection.
and upper abdominal lymph nodes were identified (Fig.
Central retroperitoneal lymphadenopathy with a few prominent lymph nodes in the left periaortic
window was also noted.
Granulomatosis with polyangiitis (Wegener's) presenting as a periaortic
The mode of identification (gross versus microscopic) and the number of hilar and suprahilar LNs as well as other regional (designated as nonhilar) LNs (including periaortic
and para-aortic, paracaval, aortocaval, common iliac, and external iliac nodes) and their tumor involvement were recorded As per the grossing protocol, hilar tissue was submitted for microscopic examination If hilar LNs were grossly visible, they were submitted separately by either the surgeon or the pathologist For the purposes of this study, hilar and suprahilar LNs were grouped together and are subsequently referred to as "hilar" unless otherwise specified.
All of the patients underwent multidetector computer-ized tomography with an 8-slice scanner for identification and mea-surement of areas of visceral adipose tissue, pericardial adipose tissue, and periaortic
Differential features of other large cell vasculitides Large cell vasculitis Differential features Kawasaki disease Fever, diffuse mucosal inflammation and dysmorphic skin rashes Cogan's syndrome Interstitial keratitis and acute onset of sensorineural hearing loss and several other neurological manifestations Syphilitic aortitis Skin, mucous membranes manifestations, Negative VDRL Rheumatoid arthritis Joint manifestations Ankylosing spondylitis Sacroilitis Retroperitoneal fibrosis Periaortic
and aortic inflammation associated with retroperitoneal and mediastinal fibrosis Behcet's disease Genital and oral aphthous ulcers, uveitis Sarcoidosis Interstitial lung diseases
They can present anywhere along the sympathetic paraganglia chains from the neck to the pelvis, but they occur most often intra-abdominally in the periaortic
region and the organ of Zuckerkandl.
Echocardiography, angiography and CT could all be used to obtain the same information as the MRI; however, CT scan with contrast enhancement is considered the method of choice, as it allows for early detection of changes in the arterial wall and periaortic
tissue and is relatively more accessible than MRI (Benenson et al.
Unlike many of the other endocrine hormone-secreting tumors, gastrinomas are often diffuse and can be present in a relatively wide tissue distribution, such as the stomach, pancreas, duodenum, and periaortic
lymph nodes (75).
Physicians also should be aware of unusually located SLNs in the periaortic
, ureteral, common iliac, and presacral areas, added Dr.
6 cm tan, firm mucosal nodule in the urinary bladder, nodular expansion of the left adrenal gland, and two enlarged periaortic
and perinephric lymph nodes.