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Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI

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Abstract

Given the unique intra-peritoneal anatomic location of the adnexa, tubo-ovarian diseases can commonly spread into the peritoneal cavity. Peritoneal seeding may occur in a spectrum of adnexal conditions including infectious diseases, endometriosis, and benign or malignant primary or secondary ovarian tumors. CT is usually the imaging modality on which the concomitant involvement of the peritoneum and the ovary is depicted. The first diagnosis to be considered by the radiologist is generally peritoneal carcinomatosis from ovarian cancer but other conditions cited above have also to be borne in mind and may be suggested on the basis of careful assessment of CT findings or on further MR findings. MRI may indeed help characterize the lesions in some cases. The purpose of this review is to describe the clinical and imaging patterns of peritoneal involvement that may be found in association with different ovarian lesions. Familiarity with these patterns and diagnoses will help the radiologist narrow the differential diagnosis and make an accurate diagnosis, thus facilitating patient management and avoiding unnecessary invasive treatment.

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References

  1. Spencer JA, Swift SE, Wilkinson N, et al. (2001) Peritoneal carcinomatosis: image-guided peritoneal core biopsy for tumor type and patient care. Radiology 221:173–177

    Article  CAS  PubMed  Google Scholar 

  2. Kim SH, Kim SH, Yang DM, Kim KA (2004) Unusual causes of tubo-ovarian abscess: CT and MR imaging findings1. RadioGraphics 24:1575–1589

    Article  PubMed  Google Scholar 

  3. Vicens RA, Patnana M, Le O, et al. (2015) Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists. Abdom Imaging 40:436–456

    Article  PubMed  Google Scholar 

  4. Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease1. RadioGraphics 22:1327–1334

    Article  PubMed  Google Scholar 

  5. Ha HK, Lim GY, Cha ES, et al. (1995) MR imaging of tubo-ovarian abscess. Acta Radiol Stockh Swed 36:510–514

    CAS  Google Scholar 

  6. Nishie A, Yoshimitsu K, Irie H, et al. (2003) Fitz-Hugh–Curtis syndrome. Radiologic manifestation. J Comput Assist Tomogr 27:786–791

    Article  PubMed  Google Scholar 

  7. Takeshita T, Shima H, Oishi S, et al. (2004) Fitz-Hugh–Curtis syndrome: hepatic capsular enhancement and diffuse gallbladder wall thickening on contrast-enhanced CT. Intern Med Tokyo Jpn 43:632–633

    Article  Google Scholar 

  8. Koc S, Beydilli G, Tulunay G, et al. (2006) Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol 103:565–569

    Article  PubMed  Google Scholar 

  9. Namavar Jahromi B, Parsanezhad ME, Ghane-Shirazi R (2001) Female genital tuberculosis and infertility. Int J Gynaecol Obstet 75:269–272

    Article  CAS  PubMed  Google Scholar 

  10. Debi U, Ravisankar V, Prasad KK, et al. (2014) Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 20:14831–14840

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee W-K, Van Tonder F, Tartaglia CJ, et al. (2012) CT appearances of abdominal tuberculosis. Clin Radiol 67:596–604

    Article  PubMed  Google Scholar 

  12. Harisinghani MG, McLoud TC, Shepard JA, et al. (2000) Tuberculosis from head to toe. Radiographics 20:449–470–529, 532

  13. De Backer AI, Mortelé KJ, De Keulenaer BL, et al. (2006) CT and MR imaging of gastrointestinal tuberculosis. JBR-BTR 89:190–194

    PubMed  Google Scholar 

  14. Wong VK, Turmezei TD, Weston VC (2011) Actinomycosis. BMJ 343:d6099

    Article  CAS  PubMed  Google Scholar 

  15. Morland D, Hassler S (2015) Pelvic actinomycosis mimicking malignant tumor. Radiology 276:304–308

    Article  PubMed  Google Scholar 

  16. Hawnaur JM, Reynolds K, McGettigan C (1999) Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy. Br J Radiol 72:1006–1011

    Article  CAS  PubMed  Google Scholar 

  17. Olive DL, Schwartz LB (1993) Endometriosis. N Engl J Med 328:1759–1769

    Article  CAS  PubMed  Google Scholar 

  18. Piketty M, Chopin N, Dousset B, et al. (2009) Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 24:602–607

    Article  PubMed  Google Scholar 

  19. Scioscia M, Bruni F, Ceccaroni M, et al. (2011) Distribution of endometriotic lesions in endometriosis stage IV supports the menstrual reflux theory and requires specific preoperative assessment and therapy. Acta Obstet Gynecol Scand 90:136–139

    Article  PubMed  Google Scholar 

  20. Chapron C, Chopin N, Borghese B, et al. (2006) Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod 21:1839–1845

    Article  PubMed  Google Scholar 

  21. Ceccaroni M, Roviglione G, Giampaolino P, et al. (2013) Laparoscopic surgical treatment of diaphragmatic endometriosis: a 7-year single-institution retrospective review. Surg Endosc 27:625–632

    Article  PubMed  Google Scholar 

  22. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL (2003) Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 18:756–759

    Article  CAS  PubMed  Google Scholar 

  23. Bottoni P, Scatena R (2015) The role of CA 125 as tumor marker: biochemical and clinical aspects. Adv Exp Med Biol 867:229–244

    Article  CAS  PubMed  Google Scholar 

  24. Scardapane A, Bettocchi S, Lorusso F, et al. (2011) Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography. Eur Radiol 21:1553–1563

    Article  PubMed  Google Scholar 

  25. Rousset P, Peyron N, Charlot M, et al. (2014) Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography—initial results. Radiology 273:117–124

    Article  PubMed  Google Scholar 

  26. Rousset P, Gregory J, Rousset-Jablonski C, et al. (2016) MR diagnosis of diaphragmatic endometriosis. Eur Radiol 26:3968–3977

    Article  PubMed  Google Scholar 

  27. Bazot M, Darai E, Hourani R, et al. (2004) Deep pelvic endometriosis: MR Imaging for diagnosis and prediction of extension of disease1. Radiology 232:379–389

    Article  PubMed  Google Scholar 

  28. Chamié LP, Blasbalg R, Pereira RMA, et al. (2011) Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics 31:E77–E100

    Article  PubMed  Google Scholar 

  29. Somigliana E, Parazzini F, et al. (2006) Association between endometriosis and cancer: a comprehensive review and a critical analysis of clinical and epidemiological evidence. Gynecol Oncol 101:331–341

    Article  PubMed  Google Scholar 

  30. Bennett GL, Slywotzky CM, Cantera M, Hecht EM (2010) Unusual manifestations and complications of endometriosis-spectrum of imaging findings. Am J Roentgenol 194:WS34–WS46

    Article  Google Scholar 

  31. Park SB, Kim JK, Kim K-R, Cho K-S (2008) Imaging findings of complications and unusual manifestations of ovarian teratomas 1. Radiographics 28:969–983

    Article  PubMed  Google Scholar 

  32. Kim MJ, Kim NY, Lee D-Y, et al. (2011) Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases. Am J Obstet Gynecol 205:32.e1–32.e4

    Article  Google Scholar 

  33. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL (1994) Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 84:22–28

    PubMed  Google Scholar 

  34. Rha SE, Bun JY, Jung SE, et al. (2004) Atypical CT and MRI manifestations of mature ovarian cystic teratomas. Am J Roentgenol 183(3):743–750

    Article  Google Scholar 

  35. Saba L, Guerriero S, Sulcis R, et al. (2009) Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol 72:454–463

    Article  PubMed  Google Scholar 

  36. Gendre J, Sebban-Rozot C, Régent D, et al. (2011) Peritoneal parasitic teratoma and chemical dermoid peritonitis. J Radiol 92:382–392

    Article  CAS  PubMed  Google Scholar 

  37. Meigs JV (1954) Fibroma of the ovary with ascites and hydrothorax; Meigs’ syndrome. Am J Obstet Gynecol 67:962–985

    Article  CAS  PubMed  Google Scholar 

  38. Brun J-L (2007) Demons syndrome revisited: a review of the literature. Gynecol Oncol 105:796–800

    Article  PubMed  Google Scholar 

  39. Morán-Mendoza A, Alvarado-Luna G, Calderillo-Ruiz G, et al. (2006) Elevated CA125 level associated with Meigs’ syndrome: case report and review of the literature. Int J Gynecol Cancer 16(315):e8

    Google Scholar 

  40. Chung BM, Park SB, Lee JB, et al. (2015) Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma. Abdom Imaging 40:1263–1272

    Article  PubMed  Google Scholar 

  41. Green GE, Mortele KJ, Glickman JN, Benson CB (2006) Brenner tumors of the ovary sonographic and computed tomographic imaging features. J Ultrasound Med 25:1245–1251

    Article  PubMed  Google Scholar 

  42. Kitajima K, Kaji Y, Sugimura K (2008) Usual and unusual MRI findings of ovarian fibroma: correlation with pathologic findings. Magn Reson Med Sci 7:43–48

    Article  PubMed  Google Scholar 

  43. Lin JY, Angel C, Sickel JZ (1992) Meigs syndrome with elevated serum CA 125. Obstet Gynecol 80:563–566

    CAS  PubMed  Google Scholar 

  44. Tanaka YO, Saida TS, Minami R, et al. (2007) MR findings of ovarian tumors with hormonal activity, with emphasis on tumors other than sex cord-stromal tumors. Eur J Radiol 62:317–327

    Article  PubMed  Google Scholar 

  45. Outwater EK, Wagner BJ, Mannion C, et al. (1998) Sex cord-stromal and steroid cell tumors of the ovary. Radiographics 18:1523–1546

    Article  CAS  PubMed  Google Scholar 

  46. Sehouli J, Senyuva F, Fotopoulou C, et al. (2009) Intra-abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer. J Surg Oncol 99:424–427

    Article  PubMed  Google Scholar 

  47. Ulbright TM, Roth LM, Stehman FB (1984) Secondary ovarian neoplasia. A clinicopathologic study of 35 cases. Cancer 53:1164–1174

    Article  CAS  PubMed  Google Scholar 

  48. Willmott F, Allouni KA, Rockall A (2012) Radiological manifestations of metastasis to the ovary. J Clin Pathol 65:585–590

    Article  PubMed  Google Scholar 

  49. Choi HJ, Lee J-H, Kang S, et al. (2006) Contrast-enhanced CT for differentiation of ovarian metastasis from gastrointestinal tract cancer: stomach cancer versus colon cancer. Am J Roentgenol 187:741–745

    Article  Google Scholar 

  50. Agarwal A, Yeh BM, Breiman RS, et al. (2004) Peritoneal calcification: causes and distinguishing features on CT. Am J Roentgenol 182:441–445

    Article  Google Scholar 

  51. Funicelli L, Travaini LL, Landoni F, et al. (2010) Peritoneal carcinomatosis from ovarian cancer: the role of CT and [18F]FDG-PET/CT. Abdom Imaging 35:701–707

    Article  CAS  PubMed  Google Scholar 

  52. Clarke-Pearson DL (2009) Screening for ovarian cancer. N Engl J Med 361:170–177

    Article  CAS  PubMed  Google Scholar 

  53. Lash RH, Hart WR (1987) Intestinal adenocarcinomas metastatic to the ovaries. A clinicopathologic evaluation of 22 cases. Am J Surg Pathol 11:114–121

    Article  CAS  PubMed  Google Scholar 

  54. Seidman JD, Kurman RJ, Ronnett BM (2003) Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol 27:985–993

    Article  PubMed  Google Scholar 

  55. Buy JN, Ghossain M (2013) Metastatic tumors of the ovary and lymphomas. In: Buy JN, Ghossain M (eds) Gynecologic imaging, 1rst edn. Berlin: Springer, pp 377–397

    Chapter  Google Scholar 

  56. Koyama T, Mikami Y, Saga T, et al. (2007) Secondary ovarian tumors: spectrum of CT and MR features with pathologic correlation. Abdom Imaging 32:784–795

    Article  PubMed  Google Scholar 

  57. Smeenk RM, Verwaal VJ, Zoetmulder FAN (2007) Pseudomyxoma peritonei. Cancer Treat Rev 33:138–145

    Article  CAS  PubMed  Google Scholar 

  58. Mukherjee A, Parvaiz A, Cecil TD, Moran BJ (2004) Pseudomyxoma peritonei usually originates from the appendix: a review of the evidence. Eur J Gynaecol Oncol 25:411–414

    CAS  PubMed  Google Scholar 

  59. Smeenk RM, van Velthuysen MLF, Verwaal VJ, Zoetmulder FAN (2008) Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol EJSO 34:196–201

    Article  CAS  PubMed  Google Scholar 

  60. Sulkin TVC, O’Neill H, Amin AI, Moran B (2002) CT in pseudomyxoma peritonei: a review of 17 cases. Clin Radiol 57:608–613

    Article  CAS  PubMed  Google Scholar 

  61. Lien W-C, Huang S-P, Chi C-L, et al. (2006) Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. Am J Emerg Med 24:801–805

    Article  PubMed  Google Scholar 

  62. Low RN, Barone RM (2012) Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 19:1394–1401

    Article  PubMed  Google Scholar 

  63. Lee KR, Scully RE (2000) Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with “pseudomyxoma peritonei”. Am J Surg Pathol 24:1447–1464

    Article  CAS  PubMed  Google Scholar 

  64. Ronnett BM, Seidman JD (2003) Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei. Am J Surg Pathol 27:650–657

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Pr Régent for providing iconographic material.

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Authors and Affiliations

  1. Lyon 1 University, Villeurbanne, France

    Audrey Ognong-Boulemo, François Golfier, Olivier Glehen, Pierre-Jean Valette & Pascal Rousset

  2. Department of Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France

    Audrey Ognong-Boulemo, Pierre-Jean Valette & Pascal Rousset

  3. Department of Body and Interventional Imaging, Hôpital Lariboisière, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France

    Anthony Dohan

  4. Department of Radiology, Hôpitaux Universitaires de Reims, Reims, France

    Christine Hoeffel

  5. Department of Radiology, McGill University Health Center, Montreal, QC, Canada

    Agatha Stanek

  6. EMR 3738, Oullins, France

    François Golfier, Olivier Glehen, Pierre-Jean Valette & Pascal Rousset

  7. Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, HCL, Pierre Bénite, France

    François Golfier

  8. Department of Surgical Oncology, Centre Hospitalier Lyon Sud, HCL, Pierre-Bénite, France

    Olivier Glehen

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  1. Audrey Ognong-Boulemo
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  2. Anthony Dohan
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  3. Christine Hoeffel
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Correspondence to Pascal Rousset.

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No funding was received for this study.

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Pierre-Jean Valette receives personal income from Philips Medical Systems for providing medical advice on image management but has no financial activities related to the present article. The other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board approval was obtained.

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Ognong-Boulemo, A., Dohan, A., Hoeffel, C. et al. Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdom Radiol 42, 1975–1992 (2017). https://doi.org/10.1007/s00261-017-1089-4

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