Primary serous papillary carcinoma of the peritoneum: CT findings

[Peritoneal carcinomatosis secondary to CUP syndrome : Diagnosis and indications for multimodal treatment]

CLINICAL PROBLEM

Peritoneal carcinomatosis secondary to cancer of unknown primary (CUP) syndrome is a rare entity for which there are no uniform treatment recommendations or guidelines. The median survival time is 3 months.

DIAGNOSIS

Computed tomography (CT), magnetic resonance imaging (MRI), and ¹⁸F‑FDG positron emission tomography (PET)/CT are valid imaging modalities for the detection of peritoneal carcinomatosis. The sensitivity of all techniques is highest for large, macronodular peritoneal carcinomatosis manifestations. A limitation of all imaging techniques is limited and small-nodular peritoneal carcinomatosis. Also, peritoneal metastasis in the small bowel mesentery or diaphragmatic domes can only be visualized with low sensitivity. Therefore, exploratory laparoscopy should be considered as the next diagnostic step. In half of these cases an unnecessary laparotomy can be avoided, because the laparoscopy revealed diffuse, small-nodule involvement of the small bowel wall and thus an irresectable situation.

TREATMENT

In selected patients, performing complete cytoreduction followed by hyperthermic intra-abdominal chemotherapy (HIPEC) is a good therapeutic option. Therefore, the identification of the extent of peritoneal tumor manifestation as accurately as possible is important for the definition of the increasingly complex oncological therapy strategies.

Magnetic resonance imaging findings of extrauterine high-grade serous carcinoma based on new pathologic criteria for primary site assignment

BACKGROUND

There has been no study that has reported magnetic resonance imaging (MRI) findings of extrauterine high-grade serous carcinomas (HGSCs) that have been histologically determined by the new criteria.

PURPOSE

To assess MRI findings of extrauterine HGSCs based on new pathologic criteria.

MATERIAL AND METHODS

Fifty patients with histopathologically proven extrauterine HGSCs, who underwent pretreatment gadolinium-enhanced MRI, were included in this study. After surgery, the primary sites were histopathologically determined based on new criteria for primary site assignment in extrauterine HGSCs as follows: fallopian tube (n = 34); ovary (n = 9); primary peritoneal HGSC (n = 1); and tubo-ovarian (n = 6). We retrospectively reviewed MR images and compared the MR findings between tubal and ovarian primaries.

RESULTS

MRI patterns with tubal primaries were classified as ovarian cancer (62%), peritoneal cancer (35%), and fallopian tube cancer (3%). MRI patterns with ovarian primaries were classified as ovarian cancer (78%) and peritoneal cancer (22%). The frequency of the involvement of the fallopian tube, ovary, peritoneum, uterus, and lymph node was not significantly different between the two pathologies. There was no significant difference in the abnormal amount of ascites, hemorrhagic ascites, or characteristics of the ovarian lesions between the two pathologies.

CONCLUSION

On MR images, tubal primaries almost always exhibited ovarian or peritoneal cancer pattern, but rarely exhibited fallopian tube cancer pattern. MR findings could not accurately differentiate between tubal and ovarian primaries; therefore, histopathologic investigation is essential for determination of the primary site of extrauterine HGSCs.

[Imaging of Mesentery and Omentum]

Although primary tumors in the mesentery and omentum are relatively rare, it is often necessary to distinguish them from other non-tumorous diseases. Since the omentum and mesentery are major routes for the spread of various abdominal diseases, the anatomy, type, and pattern of the diseases affecting these organs should be known in detail for accurate differential diagnosis. In addition, it is important to detect and promptly treat hidden lesions in the mesentery and omentum. Therefore, careful observation of the area where the lesion occur should be emphasized when assessing mesentery and omentum in abdominal CT.

Primary peritoneal serous papillary carcinoma presenting as a large mesenteric mass mistaken for ovarian cancer: a case of primary peritoneal carcinoma

Peritoneal origin serous papillary carcinoma is an uncommon primary malignancy occurring in the abdominal or pelvic peritoneum lining. It is characterized by peritoneal carcinomatosis with massive ascites, uninvolved or minimally involved ovary, and is histologically indistinguishable from ovarian serous tumors. Better recognition of this phenomenon in recent years has contributed to an increasing diagnostic frequency. We describe a rare case of peritoneal origin serous papillary carcinoma with unusual clinical presentations involving a solitary primary tumor originating from the peritoneal lining of the sigmoid colonal mesentery, without pelvic lymph node involvement or distant metastasis. Because of the location and morphological similarity, it was misdiagnosed as an ovarian malignancy. We aim to assist in the diagnosis of this disease with the following case report, thereby improving the management of patients with this condition.

Peritonealkarzinose: Präoperative Diagnostik und Patientenselektion

<b><i>Hintergrund: </i></b>Die zytoreduktive Chirurgie und die hypertherme intraperitoneale Chemotherapie spielen inzwischen eine zunehmend wichtige Rolle in der Therapie der Peritonealkarzinose bei zahlreichen Tumorentitäten. <b><i>Methode: </i></b>Die wichtigsten Selektionskriterien werden erläutert. <b><i>Ergebnisse: </i></b>Neben dem Alter und Allgemeinzustand sowie der Auswahl geeigneter Tumorentitäten spielt die Tumorlast, die möglichst exakt bereits vor der Operation abgeschätzt werden sollte, eine entscheidende Rolle. <b><i>Schlussfolgerung: </i></b>Entscheidend ist eine Selektion geeigneter Patienten, um den onkologischen Benefit zu steigern und die Morbidität zu verringern.

Peritoneal carcinomatosis: comparison of dynamic contrast-enhanced magnetic resonance imaging with surgical and histopathologic findings

OBJECTIVE

In patients with peritoneal carcinomatosis (PC) accurate preoperative assessment is essential to determine indication and surgical procedure to ensure optimal outcome. Purpose of our study was to assess the diagnostic accuracy (DA) of multiphasic dynamic contrast-enhanced MRI to determine the extent of PC in correlation with surgical and histopathological findings.

MATERIALS AND METHODS

14 Patients with proven PC were examined on a 1.5T system before peritonectomy and hyperthermic intraperitoneal chemotherapy. Patient preparation included oral application of 2000 mL mannitol solution and 40 mg butylscopolaminiumbromid i.v. Coronal contrast-enhanced multiphasic dynamic T1w 3D gre sequences (T1W DCE) (0.15 mmol Gd-chelate/kg bw) covering the whole abdomen were acquired (TR 2.9 ms, TE 1.1 ms, resolution 2.0 × 2.0 × 1.8 mm, FOV 400 × 400 mm). MRI was assessed by two radiologists and correlated with surgical exploration (SE) and histopathology for each segment based on the peritoneal cancer index proposed by Sugarbaker et al.

RESULTS

In total, 182 segments were evaluated. PC was found in 118/121 of 182 segments (reader 1/2) by MRI and in 131 segments by SE. In 4/7 segments MRI was false positive. False negative segments 17/17 in MRI did not result in irresectability. The positive predictive value for PC per segment of MRI was 97%/94%, the negative predictive value 73%/72%, the sensitivity 87%/87% and the specificity 92%/86%. The DA was 88%/87%.

CONCLUSION

T1W DCE is an accurate and clinical valuable tool for the preoperative assessment of peritoneal tumor spread.

Primary serous papillary carcinoma of the retroperitoneum: magnetic resonance imaging findings with pathologic correlation

The incidence of a primary serous papillary carcinoma of the retroperitoneum is extremely rare. We present a case of the tumour in an adult simulating an adrenal mass with MRI findings and histopathological correlation.

Peritoneal serous papillary adenocarcinoma: report of four cases

We report four cases of peritoneal serous papillary adenocarcinoma (PSPC), a rare disease; all patients had ascites and high levels of serum CA125. Clinical and radiological examinations could not differentiate the disease from peritoneal metastatic tumors and mesothelioma, and histopathological analysis including immunochemistry on the specimen obtained at laparotomy or laparoscopy was necessary for the diagnosis. One patient lived for 58 months with cytoreductive surgery and chemotherapy, and another is still living after 20 months by chemotherapy alone. In patients with peritoneal tumors of unknown origin and a high level of serum CA125, taking PSPC into consideration in the differential diagnosis, histopathological examination should be performed.

Spigelian hernia with unusual content

We present a case of a primary tumor of the peritoneum that manifested as a spigelian hernia in a 74-year-old woman. Multidetector computed tomography showed a large heterogeneous mass located subcutaneously on the right spigelian line connected to the abdominal cavity. We found no previous report describing a primary peritoneal tumor in a spigelian hernia.

Lymph node spread in stage III or IV primary peritoneal serous papillary carcinoma

BACKGROUND

The aim of this study was to determine the rates and topography of pelvic and para-aortic nodal involvement in patients with stage III or IV primary peritoneal serous papillary carcinoma (PSPC).

METHODS

Retrospective review of 19 women who underwent a systematic bilateral pelvic and para-aortic lymphadenectomy.

RESULTS

The overall frequency of lymph node involvement was 63% (12/19). Eighteen patients underwent complete resection of peritoneal disease. Only 4 patients underwent this procedure as part of their initial surgery (before chemotherapy). The frequency of pelvic and para-aortic metastases was 58% (11/19) and 58% (11/19), respectively. When para-aortic nodes were involved, the left para-aortic chain above the level of the inferior mesenteric artery was the site most frequently involved (72%). The event-free survival of the 18 patients without macroscopic disease at the end of debulking surgery was significantly correlated with the nodal status. None of the patients with positive nodes developed recurrent disease in abdominal nodes.

CONCLUSIONS

The rate of nodal involvement in patients with PSPC is high. The topography of nodal spread is similar to that of ovarian cancer. Lymphadenectomy has a prognostic value.

CT Features of Serous Surface Papillary Carcinoma of the Ovary

OBJECTIVE

The purpose of this study was to determine the CT appearance of serous surface papillary carcinoma of the ovary.

MATERIALS AND METHODS

CT scans of 17 patients with histologically proven serous surface papillary carcinoma of the ovary were retrospectively reviewed. We evaluated the ovary size, omental or mesenteric involvement (none, mild, or severe), ascites (none, small, moderate, or large), and peritoneal thickening (none, smooth, or nodular). We also noted the presence of a cul-de-sac mass, lymphadenopathy, and calcification within the peritoneal mass. The preoperative serum level of cancer antigen (CA)-125 was assessed in all patients.

RESULTS

The diameter of ovaries was 3 cm or smaller in 14 patients (82%). All patients had omental or mesenteric involvement by the tumor (mild, n = 2; severe, n = 15) and ascites (small, n = 1; moderate, n = 3; large, n = 13). Peritoneal thickening (smooth, n = 5; nodular, n = 10) was noted in 15 patients (88%) and a cul-de-sac mass in 10 (59%). Lymphadenopathy was noted in five patients (29%) and calcification within the peritoneal mass in one (6%). Serum CA-125 level was elevated in all patients (168-63,300 U/mL).

CONCLUSION

Serous surface papillary carcinoma of the ovary should be suggested as a diagnosis in patients who have peritoneal carcinomatosis, relatively normal-sized ovaries, and a highly elevated serum CA-125 level.

Primary papillary serous carcinoma of the peritoneum: Four cases and review of computed tomography findings

Primary papillary serous carcinoma of the peritoneum is an uncommon primary malignancy of the peritoneum and is histologically indistinguishable from papillary serous carcinoma of the ovary. The diagnosis of primary peritoneal papillary serous carcinoma should be considered in the presence of peritoneal and omental masses in the absence of an ovarian mass. Although it has been extensively documented in the pathological and gynaecological oncology literature, the CT appearance of primary papillary serous carcinoma of the peritoneum has been reported in only 51 cases in five reports. We present four patients with CT findings of pathologically proven primary papillary serous carcinoma of the peritoneum. There were a total of 23 patients with a histopathologically proven diagnosis of primary papillary serous carcinoma of the peritoneum between 1980 and 2002 with CT imaging. However, only four of the 23 patients' CT films were retrieved for retrospective evaluation. The rest of the films were not available as either patients had misplaced the films or patients were deceased.