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Malignant peritoneal mesothelioma: marked variability of CT findings
1Department of Radiology, J.D. Weiler Hospital, Albert Einstein College of Medicine, Bronx, NY 10461.
Abstract:
Three pathologically proven cases of malignant peritoneal mesothelioma (MPM) are shown with markedly different computed tomographic (CT) appearances. The first presented as a large enhancing pancreatic mass, a second with diffuse solid large intraperitoneal masses enveloping bowel and mesentery, and a third with predominance of ascites and small peritoneal nodules. In only one patient was there a history of possible asbestos exposure. The CT findings, pathology, and differential diagnosis of MPM are discussed.
Insights
Malignant peritoneal mesothelioma (MPM) presents with diverse computed tomographic (CT) imaging features, including pancreatic masses, diffuse intraperitoneal disease, or ascites. This highlights the importance of considering MPM in differential diagnoses despite varied CT appearances.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Malignant peritoneal mesothelioma (MPM) is a rare but aggressive neoplasm originating from the peritoneum.
- Accurate diagnosis relies on integrating imaging findings with histopathological confirmation.
- Understanding the diverse CT manifestations of MPM is crucial for timely diagnosis.
Observation:
- This study presents three pathologically confirmed cases of MPM with distinct computed tomographic (CT) appearances.
- Case 1: A large, enhancing pancreatic mass.
- Case 2: Diffuse, solid intraperitoneal masses encasing bowel and mesentery.
- Case 3: Predominance of ascites with small peritoneal nodules.
Findings:
- Computed tomographic (CT) findings in MPM can be highly variable, mimicking other intra-abdominal pathologies.
- The presented cases illustrate a spectrum from focal mass-like lesions to widespread peritoneal involvement.
- A history of asbestos exposure was present in only one of the three patients, underscoring that it is not a universal feature.
Implications:
- The varied CT appearances necessitate a broad differential diagnosis for MPM.
- Radiologists and clinicians should consider MPM even in the absence of typical risk factors like asbestos exposure.
- Early recognition of diverse CT patterns can facilitate prompt pathological evaluation and appropriate patient management for malignant peritoneal mesothelioma.