PMC3860039_01
A mass image surrounding the main vascular structures containing calcifications is observed in computerized axial tomography.
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Abdominal ultrasonography was nonspecific, while abdominal tomography revealed a mass surrounding the main vascular structures with malignant features in the location of previously nephrectomy (Fig. 1).
A mass shows hyper intense signal intensity related to adjacent muscle and aorta in coronal image of contrast abdominal computed tomography.
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We decided to use positron emission tomography (PET/CT) to determine whether the mass was malignant or benign (Fig. 2).
A mass reveals intense homogeneous uptake (arrow) in axial PET/CT fusion.
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The mass was deemed to be malignant due to increased metabolic activity with a suv max of 10.3 (normal value < 5), and surgical intervention was deemed appropriate for an apparent local recurrence of renal cell carcinoma (Fig. 3).
Operation field after resection and periaortic-pericaval lymph node dissection.
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The region of previous operation was also included in the dissection (Fig. 4).
(A) Unintentionally retained foreign objects removed from the surgical specimen is seen. (B) Laparoscopic endovascular stapler fired without removing the cover (white arrow) is observed as an example.
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The resected specimen was opened and unintentionally retained plastic foreign bodies were found (Fig. 5A). Detailed analysis of the patient's previous operative note and the hospital bill showed that an endovascular stapler [45 mm articulating vascular stapler (Ethicon Endosurgery, CA)] had been used for vascular control (Fig. 5B).