PMC5628564_01
(A) Enhanced abdominal CT. A soft-tissue density mass (arrows) of smaller than 3 cm is detected adjacent to a normal left adrenal gland. (B) Positron emission tomography-CT. Low-signal accumulation being consistent with the tumor (arrows) implies malignant potential.
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Abdominal CT showed a soft-tissue density mass of 2.8 x 2.3 cm in maximum diameter without intravenous contrast enhancement on top of the left kidney (Fig. 1A). Positron emission tomography-CT showed low-signal accumulation in the tumor, which implied malignant potential (Fig. 1B).
Intraoperative view during laparoscopic left adrenalectomy. The snake retractor pushes the tumor away outside a field of vision with the spleen. Ad, adrenal gland; Ad.V, adrenal vein; G, GIST; GIST, gastrointestinal stromal tumor; R.V, renal vein.
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During the surgery, we believed that the tumor was hiding in the adipose tissue of Gerota's fascia on top of the left kidney (Fig. 2).
Intraoperative view during the laparoscopic reoperation. No residual tissue is seen on top of the left kidney. GIST is found over the peritoneum. G, GIST; K, kidney; Pa, pancreas; Sp, spleen.
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First, we confirmed that there was no residual tissue on top of the left kidney; however, the tumor was found over the peritoneum (Fig. 3).
Intraoperative view during the laparoscopic reoperation. A GIST exists between the greater curvature of the stomach and the splenic hilum. G, GIST; K, kidney; L, liver; Sp, spleen; St, stomach.
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The tumor existed between the greater curvature of the stomach and the splenic hilum (Fig. 4).