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Perisplenic mass as initial diagnosis of malignant peritoneal mesothelioma
Christoph Petrynowski1, Albrecht Neesse1, Volker Ellenrieder1
1Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany.
Abstract:
Perisplenic masses or collections are rare findings on imaging examinations. The differential diagnostic spectrum is broad. We report the case of an 84-year-old man who presented to our emergency department with fatigue, unwanted weight loss, loss of appetite and abdominal pain. In B-mode ultrasound a very hypoechoic collection circularly located around the spleen was seen. A splenic hematoma or an abscess were primarily suspected. Performing contrast-enhanced ultrasound examination the perisplenic collection was surprisingly strongly contrasted in the arterial phase. An additional abdominal CT confirmed the mass in the left upper abdomen circularly around the spleen, compressing the left colic flexure and beginning to infiltrate the gastric fundus. An ultrasound-guided tissue biopsy was taken via a percutaneous intercostal approach, which resulted in the diagnosis of a low-grade epithelioid malignant peritoneal mesothelioma (MPM). MPM often presents with diffuse multifocal involvement of the peritoneal lining, however a unifocal manifestation of MPM is uncommon in general. A perisplenic mass manifestation of malignant peritoneal mesothelioma is an extremely rare occurrence. This case highlights the diagnostic challenges posed by the rare perisplenic manifestation of MPM.
Insights
This case report details a rare perisplenic mass diagnosed as malignant peritoneal mesothelioma (MPM). The study highlights imaging challenges in identifying this uncommon unifocal presentation of MPM.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Perisplenic masses are rare, with a broad differential diagnosis.
- Malignant peritoneal mesothelioma (MPM) typically presents as diffuse peritoneal involvement.
- Unifocal MPM, especially a perisplenic mass, is exceptionally uncommon.
Purpose of the Study:
- To report an extremely rare case of a unifocal perisplenic malignant peritoneal mesothelioma (MPM).
- To illustrate the diagnostic challenges associated with imaging perisplenic masses.
- To emphasize the importance of considering rare diagnoses in unusual presentations.
Main Methods:
- Case report of an 84-year-old male with fatigue, weight loss, and abdominal pain.
- B-mode and contrast-enhanced ultrasound (CEUS) were utilized to characterize the perisplenic collection.
- Abdominal CT confirmed the mass, and ultrasound-guided biopsy established the diagnosis.
Main Results:
- Initial ultrasound suggested splenic hematoma or abscess.
- CEUS revealed strong arterial phase contrast enhancement of the perisplenic collection.
- CT confirmed a perisplenic mass infiltrating surrounding structures.
- Ultrasound-guided biopsy diagnosed low-grade epithelioid malignant peritoneal mesothelioma (MPM).
Conclusions:
- Perisplenic masses require a broad differential diagnosis, including rare malignancies.
- Contrast-enhanced ultrasound can aid in characterizing perisplenic collections.
- This case underscores the diagnostic difficulties of unifocal perisplenic MPM, a rare entity.
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