Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation.

Peritoneal malignancies represent a diagnostic challenge for abdominal radiologists, oncologists, surgeons and pathologists in multidisciplinary teams, who must address their differential diagnosis, staging and treatment. In this article, we explain the pathophysiology of these processes and lay out the role of different imaging techniques in their evaluation. Then, we review the clinical and epidemiological aspects, the main radiological features and the therapeutic approaches for each primary and secondary peritoneal neoplasm, with surgical and pathological correlation. We further describe other rare peritoneal tumors of uncertain origin and a variety of entities that may mimic peritoneal malignancy. Finally, we summarize the key imaging findings of each peritoneal neoplasm to facilitate an accurate differential diagnosis that may impact patient management.Clinical relevance statementImaging plays an essential role in the evaluation of peritoneal malignancies, assessing their extension, detecting unfavorable sites of involvement and facilitating an accurate differential diagnosis, helping to choose the best therapeutic approach.

Efficacy and Safety of Intraoperative Hyperthermic Intraperitoneal Chemotherapy for Locally Advanced Colon Cancer: A Phase 3 Randomized Clinical Trial.

Importance: Peritoneal metastasis in patients with locally advanced colon cancer (T4 stage) is estimated to recur at a rate of approximately 25% at 3 years from surgical resection and is associated with poor prognosis. There is controversy regarding the clinical benefit of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. Objective: To assess the efficacy and safety of intraoperative HIPEC in patients with locally advanced colon cancer. Design, Setting, and Participants: This open-label, phase 3 randomized clinical trial was conducted in 17 Spanish centers from November 15, 2015, to March 9, 2021. Enrolled patients were aged 18 to 75 years with locally advanced primary colon cancer diagnosed preoperatively (cT4N02M0). Interventions: Patients were randomly assigned 1:1 to receive cytoreduction plus HIPEC with mitomycin C (30 mg/m2 over 60 minutes; investigational group) or cytoreduction alone (comparator group), both followed by systemic adjuvant chemotherapy. Randomization of the intention-to-treat population was done via a web-based system, with stratification by treatment center and sex. Main Outcomes and Measures: The primary outcome was 3-year locoregional control (LC) rate, defined as the proportion of patients without peritoneal disease recurrence analyzed by intention to treat. Secondary end points were disease-free survival, overall survival, morbidity, and rate of toxic effects. Results: A total of 184 patients were recruited and randomized (investigational group, n = 89; comparator group, n = 95). The mean (SD) age was 61.5 (9.2) years, and 111 (60.3%) were male. Median duration of follow-up was 36 months (IQR, 27-36 months). Demographic and clinical characteristics were similar between groups. The 3-year LC rate was higher in the investigational group (97.6%) than in the comparator group (87.6%) (log-rank P = .03; hazard ratio [HR], 0.21; 95% CI, 0.05-0.95). No differences were observed in disease-free survival (investigational, 81.2%; comparator, 78.0%; log-rank P = .22; HR, 0.71; 95% CI, 0.41-1.22) or overall survival (investigational, 91.7%; comparator, 92.9%; log-rank P = .68; HR, 0.79; 95% CI, 0.26-2.37). The definitive subgroup with pT4 disease showed a pronounced benefit in 3-year LC rate after investigational treatment (investigational: 98.3%; comparator: 82.1%; log-rank P = .003; HR, 0.09; 95% CI, 0.01-0.70). No differences in morbidity or toxic effects between groups were observed. Conclusions and Relevance: In this randomized clinical trial, the addition of HIPEC to complete surgical resection for locally advanced colon cancer improved the 3-year LC rate compared with surgery alone. This approach should be considered for patients with locally advanced colorectal cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT02614534.

Morbimortality after 1321 consecutive CRS + HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy.

PURPOSE: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). METHODS: Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. RESULTS: A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6-144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. CONCLUSIONS: Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%).

Concordance analysis between liquid biopsy (ctDNA) and tumor DNA molecular profiles from panel-based next-generation sequencing.

INTRODUCTION: Analysis of circulating tumor DNA (ctDNA), also known as liquid biopsy, has been postulated to be a useful test in the prognostication, molecular profiling, and monitoring of cancer patients. In this series we aimed to analyze the concordance between the mutation status of formalin-fixed paraffin-embedded (FFPE) tumor samples and matched ctDNA, considering tumor molecular profiling as the gold standard technique. METHODS: This retrospective study included cancer patients with complete diagnostics and gene mutations detected in a previous FFPE tumor tissue Next-Generation Sequencing (NGS) study with a matched frozen plasma sample available for an NGS ctDNA assay. RESULTS AND DISCUSSION: Sixty patients were included, 24 with colorectal carcinoma (CRC) and 36 with non-small cell lung cancer (NSCLC). In 27.1% of ctDNA studies a new mutation not previously detected in the matched tumor was found. 11.9% of these ctDNA results had the potential to impact clinical management. Globally, the concordance rate between FFPE tumor samples and ctDNA was 44.4%. When tumors were stratified by stage, the concordance was 76.5%, 70%, 36.4%, and 0% in tumor stages IV, III, II, and I, respectively. ctDNA molecular profiles showed a good concordance rate in advanced stage tumors and identified undetected mutations in tumor tissues. In early tumor stages the concordance was low, casting doubt on the usefulness of ctDNA in these patients.

Concordance analysis between liquid biopsy (ctDNA) and tumor DNA molecular profiles from panel-based next-generation sequencing

Introduction: Analysis of circulating tumor DNA (ctDNA), also known as liquid biopsy, has been postulated to be a useful test in the prognostication, molecular profiling, and monitoring of cancer patients. In this series we aimed to analyze the concordance between the mutation status of formalin-fixed paraffin-embedded (FFPE) tumor samples and matched ctDNA, considering tumor molecular profiling as the gold standard technique. Methods: This retrospective study included cancer patients with complete diagnostics and gene mutations detected in a previous FFPE tumor tissue Next-Generation Sequencing (NGS) study with a matched frozen plasma sample available for an NGS ctDNA assay. Results and discussion: Sixty patients were included, 24 with colorectal carcinoma (CRC) and 36 with non-small cell lung cancer (NSCLC). In 27.1% of ctDNA studies a new mutation not previously detected in the matched tumor was found. 11.9% of these ctDNA results had the potential to impact clinical management. Globally, the concordance rate between FFPE tumor samples and ctDNA was 44.4%. When tumors were stratified by stage, the concordance was 76.5%, 70%, 36.4%, and 0% in tumor stages IV, III, II, and I, respectively. ctDNA molecular profiles showed a good concordance rate in advanced stage tumors and identified undetected mutations in tumor tissues. In early tumor stages the concordance was low, casting doubt on the usefulness of ctDNA in these patients.(AU)

Introducción: Se ha postulado que el análisis de ADN tumoral circulante (ctDNA), conocido también como biopsia líquida, es una prueba útil a la hora de pronosticar, elaborar el perfilado molecular, y supervisar a los pacientes de cáncer. En esta serie nuestro objetivo fue analizar la concordancia entre el estatus mutacional de las muestras tumorales (formalin-fixed paraffin-embedded) y el ctDNA equiparado, considerando el perfilado molecular del tumor la técnica de referencia. Métodos: Este estudio retrospectivo incluyó pacientes de cáncer con diagnóstico completo y mutaciones genéticas detectadas en un estudio anterior de NGS de tejido tumoral formalin-fixed paraffin-embedded con una muestra equiparada de plasma congelado disponible para un ensayo ctDNA mediante NGS. Resultados y discusión: Incluimos sesenta pacientes: 24 con cáncer colorrectal y 36 con cáncer de pulmón de células no pequeñas (NSCLC). En el 27,1% de los estudios de ctDNA se encontró una nueva mutación no detectada previamente en el tumor equiparado. El 11,9% de dichos resultados de ctDNA tenía potencial de repercutir en el manejo clínico. A nivel global, la tasa de concordancia entre las muestras tumorales formalin-fixed paraffin-embedded y ctDNA fue del 44,4%. Al estratificar los tumores por estadio, la concordancia fue del 76,5%, 70%, 36,4%, y 0% para los estadios tumorales IV, III, II, y I, respectivamente. Los perfiles moleculares de ctDNA reflejaron una buena tasa de concordancia en tumores de estadio avanzado, e identificaron mutaciones no detectadas en los tejidos tumorales. En los estadios tumorales tempranos la concordancia fue baja, planteando dudas sobre la utilidad de ctDNA en dichos pacientes.(AU)

Tratamiento radical de la carcinomatosis peritoneal. Tiempos de cambio / Radical treatment of peritoneal carcinomatosis: Times are changing

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Aggressive Angiomyxoma: Imaging Findings in 3 Cases With Clinicopathological Correlation and Review of the Literature.

Aggressive angiomyxoma is a rare mesenchymal tumor with a typical presentation as a slowly growing perineal soft tissue mass in paravulvar and pararectal region in young adult women. We present 3 cases of aggressive angiomyxoma with clinicopathological correlation and describe their main imaging features with emphasis on magnetic resonance imaging, adding useful information about their behavior on dynamic contrast-enhanced sequences and diffusion-weighted imaging and including a comprehensive review of the existing literature.

Results of the first 100 single port laparoscopic cholecystectomies in a secondary care hospital.

INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. INCLUSION CRITERIA: symptomatic cholelythiasis patients over 16-years of age on whom a single port laparoscopic cholecystectomy was performed. EXCLUSION CRITERIA: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI>35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39,89 ± 11,5 years. The mean time of the surgical procedure was 67,94 ± 25,5 min. There were 2 cases of postoperative complications. A non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1,13 ± 0,8 days. A total of 35% patients were included in the major ambulatory surgery programme.The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery programme. We have not had serious complications. There is a high cosmetic satisfaction index with this technique.

Cirugía ultrarradical en el cáncer de ovario / Ultraradical surgery in ovarian cancer

Introducción: La cirugía ultrarradical (CU), que empezó a utilizarse para el tratamiento de cánceres gástricos, se está empleando en la actualidad como procedimiento quirúrgico en el cáncer de ovario. Consiste en el abordaje de las regiones del abdomen, la pelvis y retroperitoneales afectadas por el tumor. El objetivo de este estudio es revisar nuestra experiencia en este tipo de cirugía. Material y métodos: Se revisan de forma retrospectiva 14 casos de cáncer de ovario, tratados en el Institut Universitari Dexeus con CU entre octubre de 2003 y diciembre de 2005. Se describen diversos parámetros desde una aproximación descriptiva, utilizándose distribuciones de frecuencias y medidas de tendencia central. Resultados: En 3 pacientes la CU fue primaria, y en las 11 restantes se practicó por recidiva de la enfermedad. La citorreducción tumoral fue con un mínimo de tumor residual (inferior a 0,5 cm) y en 10 pacientes no había evidencias macroscópicas de lesión residual. Sólo una de las 4 pacientes de CU primaria recidivó a los 7 meses. La CU como segundo acto quirúrgico se produjo a los 21,5 meses de la intervención inicial. Se han producido 4 fallecimientos (36,4%), a un tiempo mediano de 8 meses (rango, 6-21). Conclusiones: En síntesis, se trata de una opción tarapéutica que en muchas ocasiones se aplica de forma paliativa. A pesar de que la casuística es escasa, la radicalidad puede aumentar la supervivencia respecto a otros actos quirúrgicos menos agresivos

Introduction: Ultraradical (UR) surgery, which was first used for the treatment of gastric cancer, is currently performed in ovarian cancer. This procedure consists of examination of all the abdominal, pelvic and retroperitoneal regions affected by the tumor. The objective of this study was to review our experience of this surgical technique. Material and methods: Fourteen cases of ovarian cancer treated in the Institut Universitari Dexeus from Barcelona (Spain), between October 2003 and December 2005 were retrospectively reviewed. The parameters were evaluated within a descriptive approach. Frequency distributions and central tendency measures were analyzed. Results: UR surgery was performed for primary tumors in three patients and for tumoral recurrence in the remaining 11 patients. Tumor reduction left minimal residual lesions (less than 0.5 cm) in 4 patients and there was no macroscopic evidence of residual lesions in 10 patients. Only one of the patients with primary UR surgery showed tumoral recurrence after 7 months. UR surgery as a second choice was performed 21.5 months after primary surgery. Four patients (36.4%) died at a median of 8 months after the second intervention (range, 6-21). Conclusions: UR surgery is a therapeutic choice that can be used as a palliative procedure. Although the number of patients in this study is small, UR surgery can improve survival in comparison with other surgical approaches