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Malignant peritoneal mesothelioma: correlation between CT imaging features and histologic subtypes
Isha D Atre1, Gaurav V Watane2, Mukesh G Harisinghani3
1Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. ishaatre@gmail.com.
Purpose:
To identify correlation between CT imaging features and histologic subtypes of Malignant Peritoneal Mesothelioma (MPM).
Methods:
This was a retrospective single-center study of 51 consecutive patients with the diagnosis of Malignant Peritoneal Mesothelioma (MPM). The tumors were classified into pure epithelioid type and those with sarcomatoid component (pure sarcomatoid and biphasic type). Imaging features of these subtypes were compared for extent and type of peritoneal thickening, omental thickening, abdominal visceral infiltration, abdominal wall infiltration, and loco-regional and distant metastases. Fisher's Exact test was used to correlate the association of imaging features with histology types followed by multivariate analysis using logistic regression test.
Results:
32 males and 19 females with a median age of 63 years (range 35-86 years) were included in the study. 41/51 (80%) were epithelioid histology type and 10/51 (20%) had sarcomatoid component (3 pure sarcomatoid type, 7 biphasic type). Abdominal visceral infiltration was seen more commonly in cases of MPM with sarcomatoid component (p = 0.001). Sarcomatoid type also had a frequent association with metastases (p = 0.001) and discrete masses (p = 0.01). Epithelioid type was commonly associated with ascites (p = 0.04). On multivariate analysis, most significant correlation was identified between the sarcomatoid type and imaging features of metastases (p = 0.001) and visceral infiltration (p = 0.019).
Conclusion:
Sarcomatoid type of MPM showed significant correlation with more aggressive imaging features of metastases and visceral infiltration as compared to epithelioid type.
Insights
Malignant peritoneal mesothelioma (MPM) subtypes correlate with distinct CT imaging features. Sarcomatoid MPM shows more aggressive signs like metastases and visceral infiltration compared to epithelioid MPM.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Malignant Peritoneal Mesothelioma (MPM) is a rare but aggressive cancer.
- Accurate subtype classification is crucial for treatment planning and prognosis.
- CT imaging is a primary tool for MPM diagnosis and staging.
Purpose of the Study:
- To correlate specific CT imaging features with histologic subtypes of Malignant Peritoneal Mesothelioma (MPM).
- To determine if imaging can help differentiate epithelioid from sarcomatoid MPM subtypes.
Main Methods:
- Retrospective analysis of 51 Malignant Peritoneal Mesothelioma (MPM) cases.
- Classification of tumors into epithelioid and sarcomatoid (pure sarcomatoid, biphasic) subtypes.
- Comparison of CT imaging features including peritoneal thickening, visceral infiltration, and metastases between subtypes using Fisher's Exact test and logistic regression.
Main Results:
- Sarcomatoid MPM subtypes (20%) showed significantly higher rates of abdominal visceral infiltration (p=0.001) and metastases (p=0.001) compared to epithelioid types (80%).
- Epithelioid MPM was more commonly associated with ascites (p=0.04).
- Multivariate analysis confirmed a strong correlation between sarcomatoid type and imaging features of metastases and visceral infiltration.
Conclusions:
- CT imaging features significantly correlate with Malignant Peritoneal Mesothelioma (MPM) histologic subtypes.
- Sarcomatoid MPM subtypes exhibit more aggressive imaging characteristics, including visceral infiltration and metastases, than epithelioid subtypes.
