Rectosigmoid Cancer and Peritoneal Carcinomatosis

 

 

 

 

 

 

 

 

 

 

       

            Patient 49 year old with a history of cancer colorectal cancer T4N2M0 stage IIIB. Underwent rectosigmoid surgery. Followed by radiation therapy and chemotherapy. Currently, presents with prominent abdomen. Correlative studies: CT, abdomen and pelvis: horseshoe kidneyt, right pelvic cystic mass, probably ovarian. Abdominal ultrasound: cholelithiasis; ascites. Chest X-ray: atelectasis of lung bases, bilateral pleural effusion.

            On the PET, there is abdominal and diaphragm distension  explained by ascites (arrow in the right hand side image), associated with diffuse increased FDG fixation in abdominal contour, more evident activity in the right flank (arrow, on left hand side image). Furthermore, a moderate intensity focus in the lower anterior inferior abdominal region. Additionally a focus of intense tracer uptake in lower anterior cervical region in the left thyroid lobe of 1.7 cm diameter. In the remainder of the study, normal distribution is observed in brain, lung, liver, spleen, colon and bladder. Kidneys have pyelocaliceal dilation.

            The findings described in abdominal cavity are compatible with peritoneal carcinomatosis. The left thyroid lobe nodule suggests a malignant lesion and should be correlated with additional tests including a biopsy.

            Despite its known limited  accuracy in detecting small peritoneal lesions and the involvement of the small bowel/mesentery, contrast-enhanced MDCT remains the standard imaging modality in the assessment of peritoneal carcinomatosis. MRI, especially with diffusion-weighted images, and FDG-PET/CT are promising methods for the evaluation of peritoneal carcinomatosis with superior results in recent studies, but still have a limited role in selected cases because of high costs and limited availability (3).

            Contrast-enhanced, multidetector computed  tomography scan remains the standard imaging modality in the assessment of  peritoneal carcinomatosis. Magnetic resonance imaging may offer complementary  valuable data. Positron emission tomography (PET) has a more limited role, its  main indication being the detection of unsuspected extraperitoneal involvement in nonmucinous neoplasms (4).
 

References:

1  Culverwell AD, Chowdhury FU, Scarsbrook AF. Optimizing the role of FDG PET-CT for potentially operable metastatic colorectal cancer.Abdom Imaging. 2012 Feb 28.

2  Ozkan E, Soydal C, Araz M, Kir KM, Ibis E. The role of 18F-FDG PET/CT in detecting colorectal cancer recurrence in patients with elevated CEA levels. Nucl Med Commun. 2012 Apr;33(4):395-402.

3   Pfannenberg C, Schwenzer NF, Bruecher BL. State-of-the-art imaging of peritoneal carcinomatosis. Rofo. 2012 Mar;184(3):205-13.

4   González-Moreno S, González-Bayón L, Ortega-Pérez G, González-Hernando C. Imaging of peritoneal carcinomatosis. Cancer J. 2009 May-Jun;15(3):184-9.


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