Common findings in pseudomyxoma peritonei in the setting of ovarian cancer: a review of 21 cases
Number:27ESURABS0026
Type:Scientific Electronic Presentation
Authors: Manuel Matos, Sofia Frade Santos, Teresa Margarida Cunha
Keywords:
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Objectives

To determine the most common imaging features of pseudomyxoma peritonei (PMP) in patients with known ovarian cancer.


Material and methods

This was a retrospective review of 21 cases of women with a definitive pathological diagnosis of ovarian cancer and confirmed PMP, identified from the database of a referral oncological centre. The imaging database spans between 2011 and 2021. Abdominal and pelvic computed tomography (CT) scans were reviewed, as were the pathology results, and patients without a definitive histological diagnosis were excluded.

Findings were initially reported by an experienced radiologist and retrospectively reviewed by another radiologist, working independently, in order to characterize evidence of PMP, associated features, and the presence of the primary ovarian tumour. The following associated features were noted: regions of mucinous ascites in the peritoneal cavity and its characteristics (morphology, volume, predominant areas, and septa or calcification in the mucinous material); visceral...

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Results

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by the accumulation of mucinous ascites within the peritoneal cavity, and can manifest through the presence of mucinous ascites, peritoneal nodules, omental nodules, and ovarian involvement. It is caused by primary low-grade mucinous tumours that arise from different sites, usually from the appendix or ovary, although most cases seem to arise from the appendix.

The correct staging of PMP is of great importance to plan the surgical approach, which usually includes surgical reduction (debulking) of the tumour and surgery combined with hyperthermic intraperitoneal chemotherapy, with or without chemotherapy in the immediate postoperative period.

Our selected patients were all female, had histologically proven PMP and ovarian cancer and had a mean age at diagnosis of 58.3 years.

Imaging findings...

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Table 1: CT features of PMP.
Image 1: Diffuse mucinous ascites in the pelvis and paracolic gutters configuring a case of large volume disease.

Conclusions

PMP is a relatively rare entity, and it is difficult to diagnose clinically. However, in the appropriate setting, for example, in patients with a known risk factor for PMP such as ovarian or appendiceal neoplasms, some imaging findings are fairly constant.

Imaging is frequently the first step in the diagnosis and management of PMP, with a significant impact on the prognosis, therefore, radiologists should be aware of common disease patterns and what to look for to be able to suggest the diagnosis with some degree of certainty.

 

[1] Fonseca C, Carvalho S, Cunha TM, Gil RT, Abecasis N. The many faces of pseudomyxoma peritonei: a radiological review based on 30 cases. Radiol Bras. Nov-Dec 2019;52(6):372-377. doi: 10.1590/0100-3984.2019.0044.

[2] Diop AD, Fontarensky M, Montoriol PF, et al. CT imaging of peritoneal carcinomatosis and its mimics. Diagn...

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