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E2995. Neoplastic and Non-Neoplastic Disorders of the Gerota's Fascia: An Overview of Gerota's Fascia and Cross-Sectional Imaging Findings
Authors
  1. Eslam Youssef; Cairo University; The University of Toledo Medical Center
  2. Mazzin Elsamaloty; The University of Toledo Medical Center
  3. Omar Gad; The University of Toledo Medical Center
  4. Hashir Faheem; The University of Toledo Medical Center
  5. Haitham Elsamaloty; The University of Toledo Medical Center
Background
Gerota’s fascia, named after Dr. Dimitrie Gerota, a Romanian physician described his fascia in 1885, is a fibrous connective tissue surrounding the kidneys and adrenal glands and separating the perinephric from paranephric fat. Understanding the perinephric anatomical spaces is crucial to understand each condition presentation and spread. The retroperitoneum is divided into: the perinephric, anterior pararenal and posterior pararenal spaces. The perirenal space has an inverted cone shape with an apex that points to the iliac fossa. Some people like to distinguish Gerota's fascia (anterior thinner perinephric fascia) from Zuckerkandl fascia (posterior thicker perinephric fascia that fuses with the parietal peritoneum). Gerota's fascia has a special importance in different staging systems. Robson and TNM staging systems revolve around the relationship to Gerota's fascia, renal vein and lymph nodes involvement. In general, Gerota's fascia tumors can arise primarily from the Gerota's fascia (leiomyoma and leiomyosarcoma), local extension from surrounding structures (renal cell carcinoma, hemangioma, retroperitoneal fibrosis, lymphangioma, Erdheim-Chester disease, angiomyolipoma, liposarcoma, myelolipoma, and extramedullary hematopoiesis) or as part of a systemic disease (lymphoma, metastases, and plasma cell tumors). Cross-sectional findings can facilitate diagnosis and management of Gerota's fascia and perinephric tumors but definitive diagnosis can only be achieved with histopathological analysis.

Educational Goals / Teaching Points
Illustrating the anatomy of Gerota's fascia and the different perinephric spaces. Describing the different neoplastic and nonneoplastic diseases that might involve the Gerota's fascia. Illustrating the imaging and histopathologic characteristics of each condition.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Cross-sectional imaging provides valuable information regarding the site, size, shape, composition, extension and relation of the tumor to the various perinephric fascia/spaces. This information definitely helps in the diagnostic and therapeutic purposes as well as monitoring and following up the effect of the procedure/treatment.

Conclusion
Knowing the Gerota's fascia and perinephric anatomy is not only helpful in diagnosing and staging the various conditions that might involve the Gerota's fascia but also helps in planing procedures and radiation therapy. Cross-sectional imaging facilitates the diagnosis and management of Gerota's fascia/perinephric tumors and understanding the radiological and pathological aspects of the different neoplastic and non-neoplastic conditions involving the Gerota's fascia/perinephric space can definitely narrow down the differential diagnosis.