Abstract
We investigated clinical significance of peritoneal thickening from metastatic renal pelvis based on pretherapy computed tomography (CT) scan findings. The criteria for inclusion were as follows: (1) pathology and CT scan confirmed metastatic renal pelvis carcinoma and (2) peritoneal thickening based on pre-therapy CT scan findings. We investigated the route of spread, gastrointestinal (GI) complications, and response to chemotherapy. A total of 68 cases were enrolled in this study, including seven patients with liver metastases and three with abdominal wall invasion. GI complications included obstruction in ten patients and bleeding in three. Response to chemotherapy demonstrated by reduced peritoneal thickening was noted in 24 patients. In conclusion. peritoneal thickening with clinical suspicion of peritoneal involvement can get indirect evidence from route of spread (liver or abdominal wall), GI complications (obstruction or bleeding) or response to chemotherapy (obvious decrease peritoneal thickening) from metastatic renal pelvis carcinoma patients. Pretherapy CT scan with peritoneal thickening should be alert that tumor has spread to the peritoneum.
Highlights
20% of patients with upper urinary tract urothelial cancers reportedly have peritoneal metastases [1]
Parietal peritoneal thickening is an important characteristic of peritoneal carcinomatosis visible on computed tomography (CT) scans
We conducted a retrospective case series study using data collected from patients with peritoneal thickening of metastatic renal pelvis cancer who were admitted to the oncology ward of Chang-Gung Memorial Hospital in Taoyuan, Taiwan, between January 2010 and December 2017
Summary
20% of patients with upper urinary tract urothelial cancers reportedly have peritoneal metastases [1]. Another report did not mention common sites of peritoneal metastases [2]. Precise diagnosis of peritoneal carcinomatosis is difficult based on imaging alone and histopathology is required for diagnosis [3, 4]. Parietal peritoneal thickening is an important characteristic of peritoneal carcinomatosis visible on computed tomography (CT) scans [3–7]. A wide variety of non-malignant etiologies, such as tuberculosis peritonitis, or a long period of peritoneal dialysis, can mimic peritoneal carcinomatosis [3, 4]. It is difficult to quantify peritoneal thickening related to carcinomatosis using the tumor burden, such as in the response evaluation criteria for solid tumors (RECIST) [8]. The kidneys are a retroperitoneal organ located behind the parietal peritoneum, and renal pelvis urothelial cancers can spread anteriorly to the peritoneum from Gerota’s fascia (renal fascia) [9]
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