Imaging of peritoneal deposits in ovarian cancer: A pictorial review

Abstract

As per incidence, ovarian carcinoma is the second most common gynaecological malignancy in women. In spite of advanced technology, patient awareness and effective screening methods, epithelial ovarian cancer is usually diagnosed at an advanced stage (stage Ⅲ). Surgical debulking of disease is mainstay of improving the patient survival even in advanced stages. Thus exact delineation of cancer spread in the abdominal cavity guides the surgeon prior to the surgery, help them to decide resectability of lesion and plan for further need of other surgical speciality or need of neoadjuvant chemotherapy. Imaging particularly well-planned contrast-enhanced computed tomography answers most of the queries raised by the treating surgeon. The aim of this article is to review the way ovarian carcinoma spread in the peritoneal cavity and to stress the accurate interpretation of cancer deposits on imaging which can help the treating team to reach optimal management of patients.

Metabolic active peritoneal sites affect tumor debulking in ovarian and peritoneal cancers

“…Round, "cake-like", ill-defined and stellate masses in the sites of mesentery and omentum were regarded as malignant involvement [4]. Bowel with wall thickening, nodular or mass-liked infiltration was regarded as bowel serosa infiltration [14]. The number of hypermetabolic sites in the peritoneum was recorded based on the aforementioned 15 sites.…”

Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation

“…The intraperitoneal area between the posterior part of the uterus and the anterior part of the rectum is the rectouterine space, or posterior cul-de-sac, and is clinically known as the pouch of Douglas, because it was described by James Douglas in 1730 (58,59). The rectouterine space is the deepest region in the peritoneal cavity, which makes it a favorable location for fluid and abscess collections and metastatic peritoneal deposits, mostly from ovarian cancer (60). Usually, a physical examination, including a thorough rectovaginal investigation, is the procedure of choice to assess the rectouterine space.…”

“…The pouch of Douglas (rectouterine space) is easily identified on axial and sagittal MR images (Figs 23, 24; Movie 16). Because of the deep location of the rectouterine space, metastases of the peritoneum may seed there, especially metastases from ovarian and colon carcinomas (60,61). MRI allows complete depiction of the rectouterine space, with further characterization of the lesions.…”

Fluorescent Nanoparticles for the Guided Surgery of Ovarian Peritoneal Carcinomatosis

“…Distant stages are characterized by the presence of cancer cells in the peritoneal cavity and/or in the retroperitoneal lymph nodes, where they can induce peritoneal carcinomatosis [ 5 ]. Peritoneal carcinomatosis suggests metastases, which in turn are localized on the peritoneum and the peritoneal organs, varying in size from microscopic lesions to cancerous masses of several centimeters [ 6 ]. Ultimately, peritoneal carcinomatosis progression leads to debilitating ascites and, above all, intestinal obstruction and subsequent lethal outcomes [ 7 ].…”