Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival

Abstract

Pseudomyxoma peritonei (PMP) is ideally treated by cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), leading to significant morbidity. Beyond the histologic grade, the prognosis lies in the completeness of cytoreduction (CC-score of 0/1 vs. 2/3) and the severe complication rate. The mucinous nature of the peritoneal implants sometimes induces liver and/or spleen scalloping on imaging. The predictive value of scalloping was assessed regarding resectability, grade, survival and severe morbidity. This monocentric, retrospective analysis compared CC-0/1 with CC-2/3 groups regarding liver and spleen scalloping parameters, assessed on pre-operative computed tomography (CT) scan, reviewed for the study. In addition, prognostic factors of severe complications and recurrence-free and overall survivals were explored in the CC-0/1 population. Overall, 129 patients were included (109 CC-0/1, 20 CC-2/3), with 58 (45%) exhibiting scalloping. All patients with splenic scalloping also had a liver one. Scalloping was more frequent (75% vs. 39%), with greater median maximal depth (21 vs. 11 mm) and higher PCI (32 vs. 14) in the CC-2/3 population, but was not predictive of either grade or survival. In CC-0/1 patients, survivals and postoperative complications were not affected by scalloping parameters. Scalloping appeared as a marker of advanced PMP, but was not predictive of grade, severe complications, or long-term outcomes.

Four cases of pseudomyxoma peritonei with ovarian tumors at our hospital

“…Contrast-enhanced CT and MRI imaging are useful in confirming the nature of the tumor and ascites, and predicting the presence of distant metastases, peritoneal dissemination, and lymph node enlargement, as well as the staging of the ovarian tumor. In addition, findings of appendiceal mucocele or the findings of liver or spleen serosal surface compression due to myxoma seeding (scalloping sign), although not seen in our cases, may also be useful as a preoperative diagnosis for PMP 16 - 18) .…”

The Cancer Diaspora: A Rare Case of Pseudomyxoma Peritonei of Appendiceal Origin

“…9 Liver scalloping, a radiologic sign made by the mass effect of the mucinous neoplasm against the liver and other viscera, is pathognomonic for PMP. 1,2,[4][5][6][7]10 In a retrospective study of 159 patients with PMP, Hotta et al 6 found that visceral scalloping on CT scans correlated with cancer recurrence after CRS. Identifying patients at risk of recurrence is crucial for selecting the appropriate treatment strategy.…”

“…1 Cytoreductive surgery and HIPEC are not without limitations and complications. Complete CRS may require extensive resections of the greater omentum or visceral peritoneum, which can lead to increased complications, decreased quality of life, 2 ileus, fistulas, gastroparesis, and abscesses. 4 Appendectomy is indicated even if the appendix appears normal or the tumor is of ovarian origin.…”

“…5 Pseudomyxoma peritonei is often asymptomatic until late in the disease course, when patients present with abdominal distention, ascites, abdominal mass, pelvic pressure, an acute abdomen, or new-onset hernia. 2,3 Complete cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is now regarded as the cornerstone of therapy due to increased survival benefits 2,6 compared with several drainage and debulking procedures done historically. 3 Be that as it may, recurrence rates are very high, even in patients with low-grade lesions.…”

“…Pseudomyxoma peritonei (PMP) is a rare neoplasm characterized by the dissemination of mucous ascites within the peritoneal cavity. 1,2 These cancer metastases often originate from a ruptured appendiceal or ovarian neoplasm, and more rarely from the colon, stomach, or pancreas. 3,4 Pseudomyxoma peritonei is more common in females around the ages of 50 to 59 years and is often an incidental finding during a laparotomy.…”