Radiomics Analysis Based on CT’s greater-omental caking for Predicting Pathological Grading of Pseudomyxoma Peritonei

Purpose: The objective of this study was to predict the preoperative pathological grading and survival period of Pseudomyxoma peritonei (PMP) by establishing models, including a radiomics model with greater mental caking as the imaging observation index, a clinical model including clinical indexes, and a combination model of these two.Methods: A total of 88 PMP patients were selected. Clinical data of patients, including age, sex, preoperative serum tumor markers [CEA, CA125, and CA199], survival time, and preoperative computed tomography (CT) images were analyzed. Three models (clinical model, radiomics model and joint model) were used to predict PMP pathological grading. The models’ diagnostic efficiency was compared and analyzed by building the receiver operating characteristic (ROC) curve. Simultaneously, the impact of PMP’s different pathological grades was evaluated.Results: The results showed that the radiomics model based on the CT’s greater omental caking, an area under the ROC curve ([AUC] = 0.878), and the combined model (AUC = 0.899) had diagnostic power n for determining PMP pathological grade.Conclusion: The imaging radiomics model based on CT greater omental caking can be used to predict PMP pathological grade, which is important in the treatment selection method and prognosis assessment.

Correlation of clinical, biochemical and radiological characteristics with histopathology of ovarian masses: hospital based descriptive study

Background: Ovarian cancer is an important cause of morbidity and mortality in the middle aged women. A systematic study of all ovarian tumours encountered in a large institute over a period of years is more likely to produce a significant amount of useful data regarding the clinical manifestations, the incidence of various types of ovarian tumours and the type of treatment offered. In this study we correlate various clinical presentations, ultrasound features, and various tumour marker levels with histopathology of ovarian masses.Methods: The study was conducted in the department of obstetrics and gynaecology in collaboration with department of radiology and pathology and lab medicine, Deen Dayal Upadhyay hospital from April 2015 to December 2016.Results: In the present study, 97 ovarian masses have been operated out of total 708 gynaecological surgeries in the obstetrics and gynaecology department of Deen Dayal Upadhyay hospital over the stipulated period. Prevalence of ovarian masses was 13.7%. Most of the ovarian masses were prevalent in the reproductive age group i.e. 21-40 years of age group in the present study though malignant masses were commonest in post-menopausal age group in the present study. 2 out 11 malignant ovarian masses were in the age group of 10-20 years which were dysgerminoma and immature teratoma respectively. Intra-operative findings like presence of mural nodule, haemorrhage and necrosis, ascites, papillary excrescences and omental caking were also found to have strong correlation with malignancy.Conclusions: A detailed preoperative workup and a simple tool loke RMI can differentiate between benign and malignant masses pre-operatively especially in post-menopausal women.

HIPEC scoring system: A preoperative model including clinical and radiographic parameters to improve patient selection.

695 Background: Most studies looking at long-term outcomes in patients undergoing cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CS/HIPEC) are based on scoring systems performed at the time of the operation. With a morbidity as high as 67%, it is crucial to carefully choose the patients who will benefit from this procedure. In this study, we evaluated preoperative factors that could impact patient outcomes. Results were used to create a predictive model for patients considered for CS/HIPEC. Methods: Patients assessed for CS/HIPEC at our tertiary cancer center between 2012 and 2017 were considered for this study. Postoperative complications, recurrence free survival (RFS) and overall survival (OS) were used as endpoints, and multivariable analysis accounting for demographics, clinical, bloodwork, radiologic and pathologic findings was performed. Results: Sixty-eight patients were considered for CS/HIPEC. Preoperative elements found to have an impact on OS were lymph node involvement (p = 0.001) and high extent of carcinomatosis (p < 0.001) on computed tomography (CT) scan. Findings that impacted RFS were lymphovascular invasion (p = 0.042), lymph node involvement (p = 0.061) and omental caking (p = 0.010) on CT. Our preoperative predictive model is presented in table. An increased rate of complications was seen in smokers (p = 0.031), obese patients (p = 0.005) and carcinomatosis diagnosed ≤ 12 months from the primary diagnosis (p = 0.069). In our experience, performing CS/HIPEC did improve OS (p = 0.036) after adjustment for age, race, smoking, and BMI. Conclusions: Preoperative findings could help physicians in their discussions with patients prior to pursue CS/HIPEC. These interesting findings will be used to inform the next step of our study: a prospective clinical trial. [Table: see text]

Adrenal heterotopic tissue in the peritoneum coincident with serous surface carcinoma

We report a case involving the concomitant presentation of two rare conditions: heterotopic adrenal tissue in the pelvic peritoneum and serous surface papillary carcinoma. A postmenopausal woman with an abdominal cystic mass and generalized ascites underwent laparotomy with the suspicion of ovarian carcinoma. Final histopathological analyses revealed serous surface carcinoma with metastasis to the endocervical canal, bilateral fallopian tubes, omentum, and para-aortic lymph nodes. Heterotopic adrenal tissue was also detected in the peritoneum. Serous surface carcinoma of the peritoneum should be considered in the differential diagnosis when ascites, omental caking, and peritoneal nodules are observed in a patient with or without an ovarian mass. Heterotopic adrenal tissue is another rare condition in adults and can be detected incidentally in the peritoneum.

Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis

A 67-year-old male presented with fatigue, abdominal pain , and 30-pound weight loss over 3 months. Computerized tomography (CT) abdomen displayed ascites with thickening and enhancement of the peritoneum and mottled nodular appearing as soft tissue consistent with omental caking worrisome for peritoneal carcinomatosis. A paracentesis revealed white blood cell count of 2,500 with 98% lymphocytes and serum ascites albumin gradient of 0.9 g/L. No acid-fast bacilli were seen by microscopic exam and culture was negative. Purified protein derivative skin test (PPD) was negative and CXR did not reveal any infiltrates. Esophagogastroduodenoscopy (EGD) and colonoscopy were unrevealing. The patient underwent exploratory laparotomy with round ligament and peritoneal biopsies that revealed numerous necrotizing granulomas. Acid-fast bacteria Ziehl-Neelsen stain (AFB) of the biopsy specimen revealed single acid-fast bacilli. Treatment for M. tuberculosis was initiated and final culture revealed that mycobacterium tuberculosis was sensitive to Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. After 6 months of treatment, the ascites and peritoneal carcinomatosis resolved.

T-cell lymphoproliferative disorder of hand-mirror cell morphology presenting in an eosinophilic loculated peritoneal effusion, with omental "caking"

Background: Cells with hand mirror morphology have not, to the best of our knowledge, been described in a primary effusion sample. This paper describes a case of T-cell lymphoma with eosinophilia in a patient with suspected peritoneal carcinomatosis. Rarely, a T-cell lymphoproliferative process may mimic primary peritoneal carcinomatosis, clinically suggested by a presentation in CT imaging of omental caking with bilateral massive loculated effusions in a patient without lymphadenopathy or splenomegaly. Methods: A 60 year old caucasian male presented with vague abdominal discomfort and increasing abdominal girth. Computed tomography showed a two centimeter thick omental cake and a small loculated effusion. The clinical presentation and imaging findings were most consistent with peritoneal carcinomatosis. Cytologic evaluation of the effusion was undertaken for diagnostic study. Results: Rapid intraprocedural interpretation of the effusion sample showed a monomorphic population of cells with hand-mirror cell morphology exhibiting cytoplasmic extensions (uropodia) with 3-5 course dark cytoplasmic granules and a rim of vacuolated cytoplasm capping the opposing mirror head side. These cells were seen within a background of mature eosinophils. Flow cytometric evaluation of the ascites fluid demonstrated an atypical T-cell population with the following immunophenotype: CD2-, CD3+, CD4-, CD5-, CD7-, CD8+, CD56+. T-cell receptor (TCR) gene rearrangement was positive for clonal TCR-gamma gene rearrangement, supporting the diagnosis of a T-lymphoprolifereative disorder. Conclusion: A T-cell lymphoproliferative process may present with hand mirror morphology in an effusion sample. These cells may show polar cytoplasmic vacuolization and 3-5 course granules within the handle of these unique cells. Cytoplasm shows peripheral constriction around the nucleus.