Dr. Pepe’s Diploma Casebook: Case 112 – The Wisdom of Dr. Pepe (Chapter 5) – SOLVED! (for real this time)

Dear Friends,

The fifth chapter of “The wisdom of Dr. Pepe” is the last presentation of this blog series and ends the present season.

The axial CT images below belong to a 37-year-old woman, who was operated on five years ago for a retroperitoneal tumour. What do you see?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Click here for the answer

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    32 Responses to : Dr. Pepe’s Diploma Casebook: Case 112 – The Wisdom of Dr. Pepe (Chapter 5) – SOLVED! (for real this time)

    1. murzin says:


    2. Wolf says:

      Lymphangioleiomyomatosis (LAM). Would speculate that the retroperitoneal tumour could have been in the kidneys (Angiomyolipoma).

    3. Mk says:

      Young woman with multiple bilateral pulmonary cysts lesions, with diffuse and aleatory widespread. Lymphangioleiomiomatosis is a good option.


    4. Sandra says:


    5. Jorge Audisio says:


    6. Dr rabia says:

      in young woman LAM is best diagnosis eith retroperitoneal another lymphatic mass or renal angiomyolipoma

    7. Elena Ludovico says:

      Istiocitosi X

    8. Jose Bacalla says:

      Lymphangioleiomiomatosis VS lymphoid intersticial pneunomia

    9. Jorge Otero says:


    10. Marky Jod Pandes says:


    11. Fabien ho says:

      Primary pattern of cyst (air image without inner vessel) with Round regular shape disseminated throughout both lungs. No nodule, no fibrosing pattern.
      Young woman
      Lymphyngioleiomyomatosis. Most likely renal tumors such as angiomyolipomas.
      If bilateral angiomyolipomas, consider syndromic tuberous sclerosis.

    12. Maksim says:


    13. Vasco Gálvez says:


    14. Daria says:


    15. Dr Pepe says:

      I made a comment about the histology of the tumor and nobody paid any attention

      • Mk says:

        Perivascular epitheloid cells tumors (PEComa) are a group of tumours that include angiomyolipomas, lymphangioleiomiomatosis, sugar cell tumors… and is in association with sclerosis tuberous

    16. Ana Calderwood says:


    17. ZHW says:

      Since lymphangioleiomyomatosis, an otherwise benign condition, belongs to the family of perivascular epitheloid cell tumours, it cannot be excluded that the lung lesions in this case in fact represent metastases from the retroperitoneal perivascular epitheloid cell tumour rather than independent neoplasms.
      J Med Case Reports. 2009; 3: 62.

      • Dr Pepe says:

        Good thinking,but it is not the case. CT was stable for more than two years. But I like your idea!

    18. genchi bari italia says:

      PECOMA E LAM appartengono alla stessa categoria di tumori mesenchimali…..quindi pecoma retroperitoneale e lam polmonare….

    19. Júlia says:


    20. Dr Pepe says:

      At this stage of the game I imagine that everybody knows that the patient has LAM associated to a PEComa. Congratulations to all of you who gave the right answer, lead by Murzin, who was the first.
      Have a nice summer vacation!

    21. Stevan Vasiljević says:

      Sorry to be the one to complain, but the article repeated lesson chapter 4, about the checklists. I suspect it was accidental. can you please put chapter 5, which represents letter ‘e’ in formula D = (bc + lv + ps + chl) e.

      • Simon Lee says:

        You’re right, it was accidental. We’re sorry about ths mistake. The real solution is now in place!

    22. Borsuk says:

      Dr. Pepe – probably the best mathematician between radiologist:)
      Great thanks for sharing Your knowledge and enthusiasm with others.
      Have a nice holiday!

    23. Lucretius says:

      where is the professor?

    24. sabry says:

      both lung cystic lesion

    25. TYRA RAHMA says:

      Lymphangioleiomiomatosis is a good option.