Correlation of radiologic with surgical peritoneal cancer. Pseudomyxoma peritonei typically occurs with a lowgrade mucinous neoplasm appendicular mucocele and some time ovarian neoplasm, nonmobile on ultrasonography. Assessment of clinical benefit and quality of life in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy hipec for management of peritoneal metastases peritoneal metastases is a significant clinical challenge. Peritoneal carcinomatosis is a type of cancer that occurs in the peritoneum. Fundamentally, it is the presence of neoplastic mucinsecreting cells in the peritoneum. The nonintravenous contrast ct abdomen, only confirmed peritoneal masses. Ct imaging of peritoneal carcinomatosis and its mimics a.
Pseudomyxoma peritonei nord national organization for. The presence of peritoneal metastases pm alters tumor staging, with direct implications in treatment choice and prognosis. Further imaging is required to characterize these lesions. Ultrasound imaging showed a uterine cavity filled with a large mass, many peritoneal nodules measuring. Mucinous appendiceal neoplasms with peritoneal spread are often clinically referred to as pseudomyxoma peritonei syndrome. Pseudomyxoma peritonei pmp and peritoneal carcinomatosis pc arises from primary or secondary peritoneal cancer and can be treated with complete surgical removal of disease. Role of imaging in peritoneal surface malignancies. Endometrial biopsy revealed grade 1 endometrioid adenocarcinoma, whereas cytology of ascites obtained from the douglas pouch showed only reactive. Despite the overlapping criteria of both pseudomyxoma peritonei and peritoneal carcinomatosis the following may be helpful in the differentiation process. Although this is the most common aetiology, especially when a primary is found, other conditions may be responsible for peritoneal invasion. Accurate peritoneal anatomy and knowledge of imaging features of peritoneal carcinomatosis is essential for appropriate management and care of patents with ovarian cancer. This article begins with an overview of peritoneal embryology and anatomy followed by a detailed description of the multimodality imaging appearance of peritoneal diseases. The obtained images were analysed using imaris software bitplane. The peritoneal carcinomatosis index was evaluated macroscopically.
Diop ad1, fontarensky m1, montoriol pf1, da ines d2. The imaging findings vary from simple ascites to multifocal discrete nodules and infiltrative peritoneal masses. Preoperative and surveillance mr imaging of patients undergoing. Ct imaging of peritoneal carcinomatosis and its mimics. Pc peritoneal carcinomatosis pci peritoneal cancer index pet positive emission tomography pfs progressionfree survival pmca peritoneal mucinous. Computed tomography and to a lesser extent sonography and mr imaging allow us to examine the complex anatomy of the peritoneal cavity accurately, which is the key to understanding the spread of peritoneal metastases. Secondary tumors and tumorlike lesions of the peritoneal. Much less commonly, mucinous tumors of colon, rectum, stomach, pancreas, and urachus 9,10, are implicated.
Pmp may not cause any problems until the tumor grows and bursts out of the area where it started. Fluid can be serous as seen in primary peritoneal carcinoma or mucinous such as found in pseudomyxoma peritonei which is typically a tumor derived from. Pseudomyxoma peritonei mri imaging pseudomyxoma peritonei is a rare condition characterized by the accumulation of copious gelatinous masses throughout the peritoneal cavity. The imaging manifestations of this condition may resemble those seen in the presence of benign. Despite the major progress that has occurred in radiological technology in the. Differentiation of pmp from disseminated mucinous carcinomatosis by imaging 4. Ros3 oei tn, jagannathan jp, ramaiya n, ros pr 1department of radiology brigham and womens hospital, harvard medical school, mellins library, 75 francis st. If peritoneal metastases are of an epithelial origin as most are and extensive, the term peritoneal carcinomatosis may also be used.
All peritoneal surface malignancies share similar radiologic features, with seeding of softtissue implants along. Much less commonly, mucinous tumours of colon, rectum, stomach, pancreas, and urachus 9,10, are implicated. Bowel obstruction and hydronephrosis are frequently seen and also the presence of ascites different from sarcomatosis 1. Cancer that has spread to the lining surfaces of the peritoneal abdominal cavity from ovarian cancer, primary colorectal cancer, appendiceal cancer, or mesothelioma and pseudomyxoma peritoneiknown as peritoneal carcinomatosisare cancers that are frequently referred to as peritoneal cancers. The tumors cause fibrosis of tissues and impede digestion or organ function, and if left untreated, the tumors and mucin they produce will fill the abdominal cavity. Pseudomyxoma peritonei pp is a clinical or radiological term, not a pathological term, and refers to a state in which a large amount of thick mucinous material is spread to the peritoneal cavity. Pseudomyxoma peritonei mri imaging radiology imaging. Computed tomography is particularly important for detailed preoperative assessment and evaluation of the radiological peritoneal cancer index. Preoperative assessment of peritoneal carcinomatosis researchgate. Carcinomatosis peritonei, computed tomography ct, tuberculous peritonitis, ovarian cancer, ca125 introduction diagnosis of tuberculous peritonitis with clinical, laboratory, and imaging findings is a difficult process.
This study aimed to develop a cumulative gcpc risk score based on individual demographictumor characteristics. Common diseases include peritoneal carcinomatosis, pseudomyxoma peritonei, lymphomatosis, sarcomatosis, and tuberculous peritonitis. Differentials include peritoneal carcinomatosis and pseudomyxoma peritonei. Pseudomyxoma peritonei, sometimes incorrectly referred to as gelatinous peritoneal disease, is characterised by the presence of a large amount of mucin in the abdomen. Mr imaging is an excellent modality for visualizing pelvic anatomic relationships in patients with complex, cystic masses.
The treatment of peritoneal carcinomatosis in advanced. Coronal and sagittal ct images demonstrate diffuse large bowel obstruction with small soft tissue. Different studies presented contrasting data about survival rates. Pc of gastric origin has an extremely inauspicious prognosis with a median survival estimate at months. The purpose of this article is to discuss the role of the radiologist in the treatment of peritoneal cancer, with focus placed on advanced treatment options and selection of patients with resectable disease for whom complete cytoreduction can be achieved. What the radiologist should know about treatment of. Gastric cancer gc peritoneal carcinomatosis pc is associated with a poor prognosis. Peritoneal carcinomatosis is the most common terminal feature of abdominal cancers.
Cytoreductive surgery crs and hyperthermic intraperitoneal chemotherapy hipec as a combined modality treatment have led to prolonged survival and even cure in selected patients with. Peritoneal carcinomatosis pc indicates the metastasis of a malignant neoplasm to the peritoneal surface. The most commonly employed imaging modalities to evaluate peritoneal carcinomatosis are ct scan, mri and petct scans. Pseudomyxoma peritonei pmp is a clinical condition caused by cancerous cells mucinous adenocarcinoma that produce abundant mucin or gelatinous ascites. Mucinous carcinomatosis mucinous carcinomatosis is the most common cystic tumor to affect the peritoneal cavity. Mri magnetic resonance imaging mump mucinous neoplasm of uncertain malignant potential. Ovarian cancer with peritoneal carcinomatosis radiology. It is most commonly caused by a mucinous tumor of the appendix 10. Coronal reconstructed ct scan image showing multiple intestinal polyps arrows, leading to ileocolic intussusception asterix and low density ascites causing scalloping of liver surface arrowhead. Could texture features from preoperative ct image be used for. Fluid produced by the cells can produce ascites which is typical in carcinomatosis, but less common in peritoneal sarcomatosis. Discussion pseudomyxoma peritonei pmp, also known as jelly belly, gelatinous ascites or false mucinous tumour of the peritoneum, is a rare complication with an estimated incidence of one to two cases per million per year. Peritoneal carcinomatosis mount sinai hospital toronto. This processing software is available on the scanner and may be called.
Peritoneal carcinomatosis may result from the metastatic spread of tumors from the gastrointestinal tract, ovary, lung. For gastrointestinal surgeons and medical oncologists, it is a vexing condition because, although the disease is limited to the peritoneal surface, complete surgical removal is impossible and systemic chemotherapy is powerless. Pseudomyxoma peritonei pmp is a rare condition that usually starts with a tumor in your appendix though the tumor also can be in your bowel, bladder, or ovaries. Suitability for surgery is based on a peritoneal cancer index pci, with a pci.
Peritoneal metastases radiology reference article radiopaedia. Imaging plays a vital role in the evaluation of peritoneal malignancies. If peritoneal metastases are of an epithelial origin as most are and extensive, the term peritoneal carcinomatosis may. However, this misconception occurs because some ovarian tumors are frequently mistakenly identified as. Less commonly, peritoneal metastases arise from mesodermal or lymphoid cell lines, with peritoneal sarcomatosis or peritoneal lymphomatosis respectively as the preferred terms 1. This study evaluates the accuracy of computed tomography ct scoring of the peritoneal cancer index pci and examines its association with surgical morbidity and outcomes in pseudomyxoma peritonei. Pseudomyxoma peritonei in a 55yearold male due to intestinal polyposis and mucinous carcinomatous transformation. Peritoneal carcinomatosis is intraperitoneal dissemination of any form of cancer that does not originate from the peritoneum itself. Peritoneal sarcomatosis versus peritoneal carcinomatosis. Multimodality imaging of common and uncommon peritoneal. Is peritoneal carcinomatosis an incurable disease or.
It is a rare condition, with a reported incidence of one case per 1 million persons per year, that is characterized by accumulation of copious gelatinous masses throughout the peritoneal cavity. It may be associated with appendiceal mucinproducing tumors or may occur as a complication of ovarian mucinous cystadenoma. It is important to be aware of the various resectable and nonresectable parameters of ovarian cancer figure 15. Gastric cancer peritoneal carcinomatosis risk score.
Imaging of peritoneal malignancy is key in the staging, management and followup in patients with both primary and secondary peritoneal malignancies. A good understanding of the complex peritoneal anatomy, modes of tumour spread and knowledge of common imaging findings help to improve detection of peritoneal involvement. Although grade, histology, and stage are associated with pc, the cumulative risk of pc when multiple risk factors are present is unknown. Pp frequently arises from appendiceal mucinous neoplasms in men and ovarian mucinous tumors in women, and the fluid may or may not contain malignant cells according to the primary lesion 3, 9.
Differential diagnoses in peritoneal carcinomatosis pseudomyxoma peritonei. Ffdgpetct to select patients with peritoneal carcinomatosis for. It is a misconception that females develop this disorder more frequently than males. A 67yearold man develops peritoneal carcinomatosis from. Pseudomyxoma peritonei radiology reference article. Imaging studies are crucial in the evaluation of patients with suspected or known peritoneal cancerous dissemination. Invasive peritoneal disease includes more than just peritoneal carcinomatosis. Peritoneal cancer, appendiceal cancer, mr imaging, heated. For statistical analysis dedicated software was used. Pseudomyxoma peritonei refers to syndrome of progressive intraperitoneal accumulation of mucinous ascites related to a mucinproducing neoplasm. Crosssectional imaging findings of pmp with examples.
Peritoneal carcinomatosis pc in patients with advanced gastric. Comparison of implantation sites for the development of peritoneal. Gastric cancer gc is the fourth most common cancer and the second leading cause of cancer death in the world. Appreciation of the spectrum of ct findings in peritoneal carcinomatosis is essential for accurate evaluation of. Pc is most commonly seen in abdominopelvic malignancies.
Carcinomatosis implants tend to be flat or ovoid and conform to the adjacent structures. Various tumours and tumour like conditions can mimic p. It is most commonly caused by a mucinous tumour of the appendix 10. Ct, and fused images were displayed with commercially available software in. In the setting of an ovarian mass, imaging findings alone cannot aid in differentiation of diffuse peritoneal malignant seeding from benign glial deposits, fig 19. Of the 26 patients without a previously known malignancy, identification of the primary tumor in addition to peritoneal carcinomatosis was possible in 50%. Detection of peritoneal metastases cancer imaging full. Tuberculous peritonitis mimicking carcinomatosis peritonei. Innumerable small cysts and thickwalled cysts may appear as softtissue attenuation lesions, necessitating peritoneal carcinomatosis and pseudomyxoma peritonei to be included in the differential diagnosis, fig 19a. Pseudomyxoma peritonei desmoid tumor omental infarction mesenteric panniculitis. Peritoneal carcinomatosis pc from gastrointestinal and gynecological cancer. Pseudomyxoma peritonei is a very rare disorder with approximately 2 cases per million individuals. Pseudomyxoma peritonei pmp is an uncommon disease affecting 1 per million population with an estimated incidence of 2 cases per 10,000 laparotomies.
Assessment of clinical benefit and quality of life in. Pet and ct alone by correlating imaging findings with intraoperative staging. Cystic masses mucinous carcinomatosis with a tumor nodule along the right paracolic gutter 3. Conclusion summary pseudomyxoma peritonei pmp is a rare condition characterized by a productive mucinous ascites, filling the peritoneal cavity.