CT Patterns of Peritoneal Metastasis in Patients with ...

ORIGINAL ARTICLE P J M H S Vol. 10, NO. 2, APR JUN 2016 565 CT Patterns of Peritoneal Metastasis in Patients with Abdominopelvic Malignancy.

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ORIGINAL ARTICLE

P J M H S Vol. 10, NO. 2, APR


JUN 2016
565

CT
Abdominopelvic Malignancy

FAROOHI SAGHIR
1
, SADIA RIAZ
2
, KAMRAN NASEEM
3

ABSTRACT

Aim:
malignancies.

This
was

a prospective studyperformed from March 2014 to October 2015 at Department of
Radiology

Bahawal Victoria Hospital, Bahawalpur. Total 190 patients with histopathological diagnosis
of primary malignancy and documented peritoneal disease on CT scan were
included in this study.

Results:

Mean age of the patients was 5312 years. Ovarian cancer was the most common cancer
seen in 114 (60%) patients. Omental caking was the most common 77(44.7%) pattern of peritoneal
involvement followed by mixed pattern in 7
1(37.4%), Nodular deposits in 28(14.7%),
Smudgedin10(5.3%) and Cystic in 4(2.1%) patients.

Conclusion:

The results of this study reveals that the ovarian and colorectalcarcinoma were the most
common. Omental caking pattern of peritoneal pattern was most
frequently observed inthese patients
followed by mixed pattern and nodularperitoneal deposits.

Key
w
ords:
Ovarian cancer, Omental caking,Colorectal cancer, Nodular deposits, Multi
-
detector CT

INTRODUCTION

The peritoneum is a continuous transparent
membrane which lines the abdominal cavity and
covers the abdominal organs (or viscera)
.Peritoneal
reflections form the greater and lesser

omenta and
spread of intraperitoneal fluid and consequentlyof
disease proces
ses within the abdominal cavity
1
,2,
3
.

Multi
-
detector CT with multi
-
planar reformation
allows

theaccurate examination of

complex anatomy
of theperitoneal cavity and helps in understanding
thepathologic processes affecting the greater and
lesser
omenta
4
.

Metastatic peritoneal tumors most often

came

fromthe carcinomas of ovary, stomach, pancreas,
colon,
uterus, and bladder
5
.

Ovarian cancer

is the
most common

abdominopelvic malignancy

andat the
time of diagnosis, about

70% of patients having

peritoneal involvement
6
,7,8,
9
.

Common sites of
intraperitoneal seeding include
the

paracolic

gutters,
omentum, liver capsule and

diaphragm. Thickening, nodularity, and enhancement

are all signs of peritoneal carcinomatosis, however,

microscopic spread of disease cannot be ruled out by

any imaging modal
ity alone and a full staging

laparotomy is always required
9
-
10
.

It is important to

determine exact extent of peritoneal disease as it

changes the staging of
disease, treatment plan and

prognosis of patie
nt, i.e., early ovarian cancer

-----------------------------------------------------------------------

1,2
Assistant Professor,
3
Senior Registrar,

Department of Radiology,
QAMedical College/BV Hospital, Bahawalpur

Correspondence to Dr. Faroohi Saghir Email
[email protected]

is
treated

with comprehensive staging laparotomy,
whereasadvanced but operable disease is treated
with primary

cyto
-
reductive surgery (debulking)
followed by adjuvantchemotherapy.9 Patient
s with
unresectable disease may
benefit from neoadjuvant
(pre
-
operative
) chemotherapy

before debulking
11
.

Characterization of different CT patterns of
peritoneal

carcinomatosis is also important as there
is predilectionof different malignancies for having
different patterns of
peritoneal disease.
12
-
13
Peritoneal
deposits can be

seenas omental caking, cystic,
nodular, smudged or may be
of mixed variety.
14
-
15
There may be pre
-
dominance ofone of these
patterns for different diseases
16,17
.

Understanding, knowledge and identification of
patterns

of peritoneal carcinomatosis can help in

diagnosis andstaging of different malignancies,
thereby improving thediagnostic accuracy and
effectively guiding patientmanagement.
The objective
of this study was to determine the patternsof
peritoneal involvement in patients with
abdominopelvicmalignanci
es.

METHODOLOGY

This
prospective
study

was
performed from
March
2014 to October 2015

at Department of

Radiology

Bahawal Victoria

Hospital,
Bahawalpur
. Institutional
Review Board and Ethics Committee approval was
taken.
Total 190

patients with peritoneal involvement
were identified on CT scan of abdomen and pelvis.
Of these,
190

patients with histopathological
diagnosis of primary malignancy and documented
CT Patterns of Peritoneal Metastasis in Patients with Abdominopelvic Malignancy

566

P J M H S Vol. 10, NO. 2, APR


JUN 2016

peritoneal disease on CT scan were included in this
study. Patients with tu
berculosis and
lymphoproliferative disorders were excluded from this
study.

CT scans were performed on 64
-
slice CT
scanner (
Aquilion
) after intravenous (I/V) contrast
injection. Three
-
mm reconstructed images were
reviewed and when necessary multiplanar
ref
were performed.

The patterns of peritoneal involvement were
identified as smudged pattern (increased de
nsity or
soft tissue
permeation of the omental fat), nodular
pattern (enhancing soft tissue nodules), om
ental
caking (diffusely thickened masses replacing normal
omental fat), cystic pattern (soft tissue masses with
cystic component) and mixed pattern (having two or
more of above described patterns). Peritoneal sites
were broadly divided into pelvic, greater

omentum
and small bowel mesentery. Associated findings of
were also evaluated. Statistical analysis was done
using SPSS version 16. Frequencies and
percentages were calculated for categorical while
mean
standard deviation (SD) were calculated for
continuous variables and graphs made
forcomprehensive review of study outcomes.

RESULTS

Total 190 patients were selected for this study.
Minimum age of the patients was 25 years and
maximum age was 75 years
with mean age 532
years. Ovarian cancer was found in 114(60%)
patients followed by colorectal cancer 42(22.1%)
patients, pancreatic cancer in 10(5.3%) patients,
cancer 4(2.1%), gallbladder 5(2.6%), hepatoce
llular
cancer 4(2.1%), cervical cancer 2(1.1%), renal cell
carcinoma 2(1.1%) patients and Transitional cell
urinary bladder cancer in on 1(0.5%) patient. (Table
1)

Table 1:
Frequencies for
primary cite of CA

Primary cite of CA

n

%age

Ovarian cancer

114

60.0

Colorectal cancer

42

22.1

Pancreatic cancer

10

5.3

Gastric cancer

6

3.2

Endometrial cancer

4

2.1

Gallbladder

5

2.6

Hepatocellular cancer

4

2.1

Cervical cancer

2

1.1

Renal cell carcinoma

2

1.1

Transitional cell urinary
bladder cancer

1

.5

The

most common pattern of peritoneal involvement
was omental caking 77(40.5%) patients, mixed in
71(37.4%) patients, nodular deposits in 28(14.7%)
patients, smudged in 10 (5.3%) and cystic in 4(2.1%)
patients. (Table 2)

Table 2:
Frequencies for pattern of p
eritoneal involvement

Pattern of peritoneal involvement

n

%age

Omental caking

77

40.5

Mixed

71

37.4

Nodular deposits

28

14.7

Smudged

10

5.3

Cystic

4

2.1

Total

190

100.0

DISCUSSION

Recognition of pattern of peritoneal involvement is of
fundamental
importance in abdominopelvic
malignancies as presence and extent of peritoneal
involvement changes the overall staging and
management plan of patient. There are no published
studies regarding this important area in our local
literature. So, it was importan
t to determine and
compare patterns of peritoneal involvement in our
country with the available foreign literature.

In our study minimum age of the patients was 25
years and maximum age was 75 years with mean
age 5312 years. Similar mean age was reported

by
In our study, most common pattern of
peritoneal involvement was omental caking 40.5%
patients, followed by mixed in 37.4% patients,
nodular deposits in 14.7% patients, smudged in 5.3%
and cystic in 2.1% patients.

Motta
et al
16

in their study reported mixed
pattern in 40% cases which is comparable with our
study.

Another study by Rodriguez
17

showed
omental caking in 36% cases which is also similar
with the findings of our study. In same study nodular
pattern was seen in 36
% cases which is very high
than our study.

4

t
he most
common pattern of peritoneal involvement was mixed
in 39% patients, omental caking in 36% patients and
nodular deposits in 24% patients. Findings of this
study are also

in agreement with our findings.

In present study ovarian cancer was found in
60% patients followed by colorectal cancer in 22.1%
patients, pancreatic cancer 5.3% patients, gastric
gallbladder 2.6%, hepat
ocellular cancer 2.1%,
cervical cancer 1.1%, renal cell carcinoma 1.1%
patients and Transitional cell urinary bladder cancer
in on 0.5% patient.

4

t
he malignancies
showing peritoneal involvement in decreasing order
Faroohi Saghir, Sadia Riaz, Kamran Naseem

P J M H S Vol. 10, NO. 2, APR


JUN 2016
567

of frequency,
were ovarian cancer in 58.12%
patients, colorectal cancer 22.17% patients,
pancreatic cancer 5.42% patients, gastric cancer
gallbladder/cholangio
-
carcinoma and hepatocellular
cancer 2.46% patients, cervica
l cancer 1.48%
patients, renal cell carcinoma 0.98% patients and
transitional cell urinary bladder cancer 0.49% patient.
All these findings are in favour of our study.

Mamlouk
18

showed ovarian carcinoma as
most common. Mamlouk
18

also showed colo
nic
and pancreatic cancers to be next in order of
frequency as a causative factor of peritoneal
carcinomatosis. Some other studies also reported
ovarian cancer

as most common
3,16
.

CONCLUSION

The results of this study reveals that the ovarian and
colorectalcarcinoma were the most common.
Omental caking pattern of peritoneal pattern was
most frequently observed inthese patients followed
by mixed pattern and nodularperitoneal deposits.

REFERENCES

1.

Ansaloni L, Piso P. The peritoneum, a still neglect
ed
organ. Its rediscovery through a new scientific journal:
the Journal of Peritoneum (and other serosal
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http://jperitoneum.org/index.php/joper/article/download/
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Zhao Z, Liu S, Li Z, Hou J, Wang Z, Ma X,
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Abdullah JS, Nadia AU, Ola A. Peritoneal
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4.

Yawar B, Babar S, Imaad
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Peritoneal Involvement in Patients with
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Pak. 2015 Jun;25(6):399

402.

5.

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of tumor in the
abdomen and pelvis. World J Radiol. 2013 Mar
28;5(3):106

12.

6.

Griffin N, Burke C, Grant LA. Common primary
tumours of the abdomen and pelvis and their patterns
of tumour spread as seen on multi
-
detector computed
tomography. Insights Imaging
. 2011 Apr 14;2(3):205

14.

7.

Paula JW, Keyanoosh H, Jeff SS. Radiologic staging
of ovarian carcinoma with pathologic correlation
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AFIP
archives.
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8.

Harpreet KP, Robert EB, Frederick JM, Elliot KF.
Multidetector CT of peritoneal
carcinomatosis from
ovarian cancer
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Radio Graphics
2003;
23
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-
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9.

Siddall KA, Rubens DB. Multidetector CT of female
pelvis.
RadiolClin N Am
2005;
40
:1097
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10.

Tempany CM, Zou KH, Silverman SG, Brown DL,
Kurtz AB, McNeil BJ. Staging of advanced ovarian
cancer: comparison of imaging modalities
-

Report
from Radiological Diagnostic Oncology Group.
Radiology
2000;
215
:761
-
7.

11.

Schwartz PE, Chambers JT, Makuch R. Neo
adjuvant
chemotherapy for advanced ovarian cancer.
GynecolOncol
1994;
53
:33
-
7.

12.

Vassilios R, Nicholas G. Peritoneal carcinomatosis.
EurRadiol
2001;
11
:2195
-
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13.

Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn
ST. CT and MR imaging of ovarian tumors with
emp
hasis on differential diagnosis.
Radio Graphics
2002;
22
:1305
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14.

Kim HJ, Kim JK, Cho KS. CT features of serous
surface papillary carcinoma of the ovary.
AJR Am J
Roentgenol
2004;
183
:1721
-
4.

15.

Naheed I, Malik S, Shaukat MS. Review of ovarian
tumors.
Ann K
ing Edward Med Coll
2001;
7
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2.

16.

Motta R, Gaspar A, Torres H. Peritoneal
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computed tomography (MDCT).
GAMO
2010;
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-
54.

17.

Rodrguez E, Pombo F. Peritoneal tuberculosis versus
peritoneal carcinomatosis: d
istinction based on CT
findings.
J Comput Assist Tomogr
1996;
20
:269
-
72.

18.

Mamlouk MD, Vansonnenberg E, Shankar S. Omental
cakes:unusualaetiologies and CT appearances.
Insights Imaging
2011;
2
:399
-
408.

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