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Unusual radiologic presentations of malignant peritoneal mesothelioma
Paul Hendrick Sugarbaker1, James S Jelinek2
1Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States. paul.sugarbaker@outlook.com.
Background:
Malignant peritoneal mesothelioma is an unusual disease process characterized radiologically by ascites and infiltration of the peritoneum by multiple small tumor nodules. Both parietal and visceral peritoneum are involved by the multiple malignant tumor nodules. Computed tomography (CT) has been used to identify the anatomic pathology induced by the progression of this malignant process.
Aim:
To identify and then describe unusual CT images in patients with malignant peritoneal mesothelioma. Recognition of these unusual radiologic findings can cause the radiologist to be suspicious of this rare malignant process.
Methods:
In 100 patients who were to undergo definitive treatment of malignant peritoneal mesothelioma, the findings on preoperative CT scans were catalogued. Many of these changes were repeatedly noted on the CT scans. Other pathologic CT images were less common. These unusual radiologic presentations were specially studied in this manuscript.
Results:
Eight unusual radiologic presentations of malignant peritoneal mesothelioma were selected for study. These unusual findings included a mass occurring within a Spigelian hernia, infiltration of the splenic parenchyma by spherical mesothelioma masses, infiltration of the lower mediastinum by tumor, a mesothelioma mass within a left inguinal canal, enlarged cardiophrenic angle lymph nodes, pleural plaques associated with the progression of malignant peritoneal mesothelioma, splenic notches caused by disease surrounding the spleen, and a mass greater than 5 cm associated with the proximal jejunum and directly adjacent to the anatomic location of the Treitz ligament.
Conclusion:
There are unusual radiologic presentations of malignant peritoneal mesothelioma that are important to recognize in order to accurately diagnose this disease by CT.
Insights
Malignant peritoneal mesothelioma presents with unusual computed tomography (CT) findings, including masses in hernias and spleen infiltration. Recognizing these rare CT signs aids radiologists in diagnosing this uncommon cancer.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Malignant peritoneal mesothelioma is a rare cancer characterized by ascites and peritoneal infiltration.
- Computed tomography (CT) is crucial for identifying the anatomical changes caused by this disease.
Purpose of the Study:
- To identify and describe unusual CT imaging findings in malignant peritoneal mesothelioma.
- Enhance radiologist suspicion for this rare condition through recognition of atypical presentations.
Main Methods:
- Analysis of preoperative CT scans from 100 patients with malignant peritoneal mesothelioma.
- Cataloging and studying common and uncommon radiologic findings.
Main Results:
- Eight unusual CT presentations were identified.
- Findings included masses in Spigelian hernias, splenic infiltration, mediastinal involvement, inguinal masses, enlarged lymph nodes, pleural plaques, splenic notches, and jejunal masses.
Conclusions:
- Unusual CT findings in malignant peritoneal mesothelioma are critical for accurate diagnosis.
- Radiologists must be aware of these atypical presentations for timely diagnosis.
