CT imaging of peritoneal carcinomatosis and its mimics

Our plain-English summary of CT imaging of peritoneal carcinomatosis and its mimics, by A.D. Diop, M. Fontarensky, P.F. Montoriol, et al (Diagnostic and Interventional Imaging, 2014).

The study

• Authors: A.D. Diop, M. Fontarensky, P.F. Montoriol, D. Da Ines
• Journal: Diagnostic and Interventional Imaging
• Published: 2014;95(9):861-72
• Type of article: Review
• Cited by: 92 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Invasive peritoneal disease includes more than just peritoneal carcinomatosis. Although this is the most common aetiology, especially when a primary is found, other conditions may be responsible for peritoneal invasion. A rigorous analysis of CT features taken together with the clinical and biological context usually allows the main differential diagnoses, which entail different types of management, to be drawn out. Pseudomyxoma peritonei, peritoneal lymphomatosis, tuberculosis, peritoneal mesothelioma, diffuse peritoneal leiomyomatosis, and benign splenosis are the main differential diagnoses.

Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

In plain English

This article was an iconographic (pictorial) review that used CT scans to show the key signs of peritoneal carcinomatosis, which is the spread within the abdominal lining of a tumour that did not start there, and the main conditions that can look like it. It did not study a defined group of patients or measure any risk. Scans of individual patients served as examples. The mimics covered were malignant peritoneal mesothelioma, pseudomyxoma peritonei, peritoneal lymphomatosis, peritoneal tuberculosis, splenosis implants and diffuse peritoneal leiomyomatosis. On mesothelioma, the review stated, citing earlier sources, that peritoneal involvement is reported in 25% of cases. It also stated, without giving a source or its own data, that asbestos exposure is found in one in every two cases of peritoneal mesothelioma. It described the CT features of mesothelioma as similar to carcinomatosis, including ascites and thickening of the peritoneal lining. It listed occupational asbestos exposure, pleural abnormalities such as calcified plaques, and no detectable primary tumour as clues pointing to mesothelioma. No asbestos fiber types were named. The authors concluded that many mimics are easy to recognise or propose from a rigorous assessment of CT features and the clinical context. They noted that their list was not exhaustive.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Iconographic (pictorial) review of CT imaging
• Who was studied: No defined patient group or case count. The subject was the CT appearance of peritoneal carcinomatosis (intraperitoneal spread of a tumour not originating from the peritoneum) and its mimics, illustrated with scans of individual patients, including a male with diffuse malignant peritoneal mesothelioma.
• Exposure: No exposure was studied. The review mentions occupational exposure to asbestos as a clinical feature pointing to peritoneal mesothelioma. No fiber types, products or doses are given.
• Main results:
  • The review named malignant peritoneal mesothelioma (clue: asbestos exposure), pseudomyxoma peritonei (clue: scalloping) and peritoneal tuberculosis (clues: necrotic lymph nodes and calcifications) among the main disorders that mimic peritoneal carcinomatosis. Peritoneal lymphomatosis was also named.
  • Splenosis implants were described as able to mimic tumour implants in the peritoneum.
  • Diffuse peritoneal leiomyomatosis, described as rare and benign, was also covered as a mimic.
  • Background statement citing earlier sources: in mesothelioma, peritoneal involvement is reported in 25% of cases.
  • Background statement, with no source cited and no data from this article: asbestos exposure is found in one in every two cases of peritoneal mesothelioma.
  • CT features of peritoneal mesothelioma described as resembling carcinomatosis: ascites, diffuse and/or nodular thickening of the peritoneal lining, invasion of the greater omentum, and mesenteric masses.
  • Pleural abnormalities such as calcified plaques, suggestive of asbestos exposure, were listed as a feature pointing to mesothelioma.
  • Absence of a detectable primary tumour was listed as another feature associated with mesothelioma.
• The authors' conclusion: The authors concluded that there are quite a number of differential diagnoses that are easy to recognise or propose based on a rigorous assessment of CT features and the clinical context.
• Limitations the authors state:
  • The authors note that their list of mimics is not exhaustive.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma.

Related studies

• CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis — Y.F. Liang, G.Q. Zheng, et al. (2016)
• Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis — J.D. Rivard, W.J. Temple, et al. (2014)
• Peritoneal well-differentiated papillary mesothelioma coexisting with endometrial adenocarcinoma mimicking peritoneal carcinomatosis: A case report — Y.Y. Chen, P.C. Li, et al. (2020)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)

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