--- a
+++ b/data/text/es-S0210-48062004000400012-1.txt
@@ -0,0 +1,15 @@
+A 66-year-old man was referred by the Gastroenterology Department due to the finding of a 25 cm retroperitoneal mass on abdominal ultrasound performed for dyspepsia. His personal history included: old pulmonary tuberculosis and chronic obstructive pulmonary disease. Physical inspection revealed a large mass deforming the right anterior hemiabdomen, extending from the subcostal area to the pubis. On palpation, the mass was painless, firm in consistency, with no signs of peritoneal irritation and dull to percussion. Rectal palpation revealed a prostate of size II/V, adenomatous, smooth and well-defined. Blood tests, urine sediment and urine culture were normal, and the PSA level was 1.2 ng/ml.
+Abdominal ultrasound showed a cystic lesion 25 cm in diameter, with abundant internal echoes, extending from the lower edge of the liver to the groin.
+IV urography (IVU) showed distortion of the right renal silhouette and pelvis, with significant displacement of the lumbo-iliac segment of the right ureter, extending beyond the abdominal midline, as well as slight ectasia of the ipsilateral upper urinary tract.
+
+The abdomino-pelvic CT scan performed with oral and intravenous contrast showed a right retroperitoneal polylobulated cystic retroperitoneal mass of 25 cm in cranial-caudal diameter, extending from the subhepatic region to the groin, compressing and displacing the right kidney, the psoas iliacus muscle and the ascending colon, posteriorly and medially. Punctate calcifications were also observed in the cystic wall. In the medial and inferior portion of the mass there was a tubular structure of 2 cm in diameter and 7 cm in length, with progressive tapering in a caudal direction, ending in a complete stop. The right kidney was functionally normal. The CT findings were interpreted as a possible dysplastic right lower kidney with partial agenesis of the ureter.
+
+Given the existing diagnostic doubts with the radiological studies performed, it was decided to perform a percutaneous puncture-biopsy, which was reported as a cystic lesion wall, and urine cytology, which showed no evidence of malignant cells.
+Subsequently, surgery was performed via a right pararectal approach, showing a cystic mass related at its cranial end to the right hepatic lobe and the lower pole of the kidney, and at its caudal end to the space of Retzius and the internal inguinal orifice. No intra-abdominal organ infiltration was observed. Careful resection of the cystic mass and the cecal appendix, which was in close relation to the caudal portion of the cystic mass, was performed.
+
+Pathological examination of the specimen revealed a dilated appendix, lined by a cytologically benign mucinous epithelium, which formed papillary-like structures. These findings were diagnostic of mucinous cystadenoma of the appendix.
+
+The postoperative course was normal. The IVUS performed three months after surgery showed good bilateral renal function, with lateral hypercorrection of the right ureteral tract and disappearance of the right renal distortion.
+
+At the 20-month check-up, the patient was asymptomatic from the urological point of view, and the control CT scan showed no abdominal lesions suggestive of peritoneal pseudomyxoma.
+