Multicystic peritoneal mesothelioma treated with cytoreductive surgery followed or not by hyperthermic intraperitoneal chemotherapy: results from a large multicentric cohort
Abstract:Background: Multicystic peritoneal mesothelioma (MCPM) is a rare, slowly growing, condition prone to recur after surgery. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) added to complete cytoreductive surgery (CRS) remains controversial and difficult to assess. As patients are mostly reproductive age women, surgical approach, and fertility considerations are important aspects of the management. This observational retrospective review aimed to accurate treatment strategy reflections. Methods: The… Show more
“…Patients suspected of having multicystic peritoneal mesothelioma should be referred to a specialized center for a comprehensive evaluation, which includes obtaining an accurate pathological diagnosis. Treatment options, such as complete cytoreduction with or without hyperthermic intraperitoneal chemotherapy, can be discussed to minimize recurrence or potential malignant transformation [ 64 ]. Fig.…”
Section: T1-hyperintense Differential Diagnosis and Pitfalls For Pelv...mentioning
confidence: 99%
“…Multicystic peritoneal mesothelioma Multicystic peritoneal mesothelioma is a rare benign neoplasm arising from the peritoneum [63]. It is often found in women of reproductive age, with a preferential location in the pelvis, and can be discovered incidentally or present with symptoms such as heaviness, distension, or pain [64]. These mesotheliomas appear as well-defined cystic lesions, typically over 10 cm in size, with grape-like clusters and possible mild septal enhancement.…”
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
Graphical Abstract
“…Patients suspected of having multicystic peritoneal mesothelioma should be referred to a specialized center for a comprehensive evaluation, which includes obtaining an accurate pathological diagnosis. Treatment options, such as complete cytoreduction with or without hyperthermic intraperitoneal chemotherapy, can be discussed to minimize recurrence or potential malignant transformation [ 64 ]. Fig.…”
Section: T1-hyperintense Differential Diagnosis and Pitfalls For Pelv...mentioning
confidence: 99%
“…Multicystic peritoneal mesothelioma Multicystic peritoneal mesothelioma is a rare benign neoplasm arising from the peritoneum [63]. It is often found in women of reproductive age, with a preferential location in the pelvis, and can be discovered incidentally or present with symptoms such as heaviness, distension, or pain [64]. These mesotheliomas appear as well-defined cystic lesions, typically over 10 cm in size, with grape-like clusters and possible mild septal enhancement.…”
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
Graphical Abstract
“…In gastric cancer, isolated PC is found in 5–20% of patients who undergo surgical exploration for potentially curative resection [ 5 ]. In infrequent cancers such as pseudomyxoma peritonei and peritoneal mesothelioma, CRS HIPEC is a standard of care, whenever a patient is fit for major surgery [ 4 , 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Thus, in expert centers providing CRS HIPEC, cure rates above 80% are reported for pseudomyxoma peritonei [ 6 , 10 , 17 , 18 , 19 ].…”
Peritoneal cancer (PC) is a dire finding, yet in selected patients, long-term survival is possible. Complete cytoreductive surgery (CRS) together with combination immunochemotherapy is essential to achieve cure. Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are increasingly added to the multimodal treatment. The Swiss Peritoneal Cancer Group (SPCG) is an interdisciplinary group of expert clinicians. It has developed comprehensive treatment algorithms for patients with PC from pseudomyxoma peritonei, peritoneal mesothelioma, gastric, and colorectal origin. They include multimodal neoadjuvant treatment, surgical resection, and palliative care. The indication for and results of CRS HIPEC and PIPAC are discussed in light of the current literature. Institutional volume and clinical expertise required to achieve best outcomes are underlined, while inclusion of patients considered for CRS HIPEC and PIPAC in a clinical registry is strongly advised. The present recommendations are in line with current international guidelines and provide the first comprehensive treatment proposal for patients with PC including intraperitoneal chemotherapy. The SPCG comprehensive treatment algorithms provide evidence-based guidance for the multimodal care of patients with PC of gastrointestinal origin that were endorsed by all Swiss clinicians routinely involved in the multimodal care of these challenging patients.
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