Posterior renal adenoma

　　The etiology of retroperitoneal adenoma is not yet clear, and race and geographical conditions are not important factors causing retroperitoneal adenoma. Some reports suggest that aromatic hydrocarbons, aromatic amines, aflatoxins, hormones, radiation, and viruses can cause retroperitoneal adenoma; certain genetic diseases such as tuberous sclerosis and multiple neurofibromatosis can be associated with renal cell carcinoma. Some scholars proposed in 1990 that smoking is related to retroperitoneal adenoma, and the risk of developing retroperitoneal adenoma is twice as high in smokers compared to non-smokers, and the incidence rate is higher in heavy smokers than in light smokers. The duration of smoking is directly related to the incidence rate, and it is believed that the content of various mutagenic substances in the urine of smokers is increased; dimethyl nitrosamine in tobacco can cause retroperitoneal adenoma, although it has not been confirmed, animal experiments have induced retroperitoneal adenoma in rabbits, so they believe that smoking habits plus other risk factors such as alcoholism, occupational exposure, etc., can further increase the risk of developing retroperitoneal adenoma. Male smokers are one of the causes of retroperitoneal adenoma, while female smokers seem to be unrelated. Male smokers exposed to cadmium industrial environments have a significantly higher incidence of renal cancer than others. Coffee may increase the risk of retroperitoneal adenoma, but it is not related to the amount of coffee consumed. Retroperitoneal adenoma also has a familial predisposition.

　　Retroperitoneal adenoma is a relatively benign tumor with a good prognosis. However, in clinical practice, because it is difficult to differentiate from malignant tumors, radical nephrectomy is often performed, and the diagnosis is confirmed by postoperative pathology. Common complications are as follows.

　　1. Lumbar pain:It is a common symptom of retroperitoneal adenoma, most of which are dull pain, localized in the lumbar region. Pain is seen in about 50% of cases and is also a late symptom. It is caused by the stretching of the renal capsule or renal pelvis by the gradually growing tumor, or by the persistent pain in the lateral lumbar region due to the invasion and compression of the retroperitoneal connective tissue, muscle, lumbar vertebrae, or lumbar nerves by the tumor. The pain can also be caused by blood clots passing through the ureter, which is characterized by renal colic.

　　2. Anemia:Patients with retroperitoneal adenoma often have anemia, which is generally believed to be caused by chronic hemorrhage. However, some patients have anemia without a history of hematuria, which may be related to the toxin of retroperitoneal adenoma or the destruction of renal tissue inhibiting the hematopoietic mechanism.

　　3. Hypertension:About 10-15% of patients with retroperitoneal adenoma have hypertension, which may be caused by tumor compression of renal vessels, the formation of arteriovenous fistula within the tumor, or excessive secretion of renin or an unknown hypertensive substance.

　　4. Abnormal liver function:Patients with retroperitoneal adenoma often have abnormal liver function, which is often reversible and common in clear cell carcinoma. It is often restored to normal after surgical resection.

　　Most patients have no obvious symptoms and signs, 50% of the cases are found incidentally, and about 10% of the patients may be accompanied by polycythemia, which may manifest as lumbar and abdominal pain, hematuria, mass, and intermittent fever, and may be accompanied by symptoms related to hereditary pseudo-Hemophilia.

　　1. Increase in blood pressure:9% to 28% of patients with retroperitoneal adenoma have hypertension, and sometimes hypertension can be the only manifestation. Patients with an increase in blood pressure in a short period of time should consider both hypertension and symptomatic hypertension caused by other diseases.

　　2. Hematuria:Hematuria is the most common early sign of retroperitoneal adenoma. Sometimes gross hematuria can be seen, while sometimes it can only be detected under a microscope. There is no pain, and gross hematuria only appears in the late stage of retroperitoneal adenoma. If hematuria, especially gross hematuria, is found, it should be checked immediately by a urologist.

　　3. Fever:In the symptoms of retroperitoneal adenoma, fever is an indispensable signal. 10% to 20% of patients with retroperitoneal adenoma have symptoms such as low fever, night sweats, or high fever, intermittent fever.

　　Retroperitoneal adenoma is a relatively benign tumor with a good prognosis. However, in clinical practice, because it is difficult to differentiate from malignant tumors, radical nephrectomy is often performed, and the diagnosis is confirmed by postoperative pathology.

　　1. Avoid contact with carcinogens such as aromatic hydrocarbons, aromatic amines, aflatoxins, and radiation.

　　2. Quit smoking, drinking, and reduce coffee intake. Reasonably adjust the diet, with a diet rich in nutrition, light, low in sugar and salt as the main content.

　　3. Participate moderately in national fitness activities, strengthen physical fitness training, improve the body's immune function and disease resistance. Some appropriate exercises, such as Qigong, Tai Chi, jogging, etc., are beneficial to mobilize the positive factors of the whole body to enhance disease resistance.

　　4. Adjust one's mental and emotional state well, maintain an optimistic outlook on life.

　　5. Pay attention to the changes of the whole body. If there is a gradual increase in fatigue, loss of appetite, weight loss, anemia, and other conditions, it is necessary to go to the hospital for a check-up in time.

　　Imaging diagnosis of retroperitoneal adenoma, abdominal ultrasound and CT scan are the most commonly used examination methods, which also enable early detection in a few asymptomatic patients. In addition, abdominal MRI has been widely used in recent years. Through ultrasound, CT, or MRI, the size, location, local spread, lymph node involvement, and vascular invasion of retroperitoneal adenoma can be understood. Intravenous urography is helpful to understand the renal function of both sides and the condition of renal pelvis, ureter, and bladder, which is of reference value for treatment.

　　Ultrasound examination

　　Mostly well-defined, oval, hyperechoic or hypoechoic solid masses, with possible liquid dark areas and surrounding hypoechogenic rings. Cystic-like manifestations are rare.

　　CT examination

　　CT plain scan shows clear tumor margins, with the surrounding renal parenchyma mostly of low density, isodensity, or uniform high density. There may be patchy hemorrhage, necrotic cystic areas, and punctate calcification. After enhancement, the parenchymal part is usually without or minimally enhanced, and there may also be delayed enhancement.

　　MR examination

　　MRT1WI usually shows low signal intensity, while T2WI shows low or slightly high signal intensity. Most cases of Malignant Adenoma can be cured after simple tumor resection. There are reports of metastasis to bone and lymph nodes in literature, therefore, long-term imaging surveillance and follow-up should be performed after surgery. Clinically, if a kidney mass accompanied by polycythemia and relatively typical CT findings is encountered, the possibility of Malignant Adenoma should be considered.

　　Retroperitoneal adenoma is an extremely rare benign tumor and is usually considered a benign tumor. Some people believe that retroperitoneal adenoma originates from renal primordial cells. Also, some studies suggest that there is a close relationship between papillary renal cell carcinoma and retroperitoneal adenoma, which can occur at any age, most commonly between 50 to 60 years old. The specific diet is as follows.

　　1. Change bad living habits, quit smoking and drinking, drink tea moderately, and drink less coffee.

　　2. Pay attention to the adjustment of diet, do not eat or eat less fried, smoked, pickled, and high-fat, high-cholesterol foods.

　　3. Pay attention to rest and avoid fatigue.

　　4. All foods that may affect kidney function or increase the burden of kidney excretion should be handled with caution, such as all high-purine foods, high-fat foods, soybeans, etc., should be eaten cautiously, and it is better to eat less or not at all.

　　5. Retroperitoneal adenoma patients often have kidney deficiency, and the dietary structure should not only increase general nutrition but also appropriately supplement some kidney and liver-nourishing, diuretic and small-particle products, such as black fungus, mulberry, duck, black carp, perch, river crab, river shrimp, goji, pear, mushrooms, loquat, kiwi, mulberry, watermelon, winter melon, Job's tears, mung bean, red bean, tea, etc.

　　Retroperitoneal adenoma is a relatively benign tumor with a good prognosis. However, in clinical practice, because it is difficult to differentiate from malignant tumors, radical nephrectomy is often performed, and the diagnosis is confirmed by postoperative pathology.

　　One, surgery is the main method for curing retroperitoneal adenoma. The principle of surgical treatment is that patients in stages I to II should undergo radical nephrectomy and regional lymph node dissection. The surgical scope includes the affected kidney, perirenal fat, perinephric fascia, ipsilateral adrenal gland, paraaortic aorta, surrounding inferior vena cava, lumbar plexus, and lymph nodes on the surface of the lumbar muscles. For patients with retroperitoneal adenoma invasion of renal capsule, renal pelvis, and lymph node metastasis, postoperative radiotherapy should be performed after surgery to reduce local recurrence, but whether it can improve survival is yet to be determined. For patients with lymph node metastasis, vascular and/or thrombus cancer栓, chemotherapy or immunotherapy should be performed after surgery.

　　Two, the biological multi-targeted therapy for renal cell carcinoma, the zero-toxic and targeted characteristics of the marine biological preparation Aikexin have great advantages in the treatment of retroperitoneal adenoma, which can be throughout the treatment process of retroperitoneal adenoma, providing a new treatment option for patients who cannot be surgically cured.