CT of peritoneal mesothelioma: analysis of eight cases

Our plain-English summary of CT of peritoneal mesothelioma: analysis of eight cases, by N.O. Whitley, D.E. Brenner, K.H. Antman, et al (AJR. American Journal of Roentgenology, 1982).

The study

• Authors: N.O. Whitley, D.E. Brenner, K.H. Antman, D. Grant, J. Aisner
• Journal: AJR. American Journal of Roentgenology
• Published: 1982;138(3):531-5
• Cited by: 62 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In order to define the computed tomographic appearance of mesothelioma, eight patients with histologically proven peritoneal mesotheliomas had computed tomography (CT) performed during the course of their disease. CT findings for all cases were analyzed for evidence of tumor involvement in the peritoneum, mesentery, liver, bone, lymph nodes, and lower pleural space, and for ascitic and pleural fluid. CT findings included evidence of peritoneal involvement (7/8 patients, 88%), ascites (6/8, 75%), mesenteric involvement (6/8, 75%), pleural involvement (4/7, 57%), bone destruction (2/8, 25%), peritoneal mass (1/8, 12%), and retroperitoneal lymph node involvement (1/8, 12%). On the basis of diffuse mesenteric and peritoneal involvement and high incidence of ascites, CT may suggest the diagnosis of peritoneal mesothelioma; however, it may be difficult to differentiate from carcinomatosis, gastrointestinal malignancies, ovarian carcinomas, and, rarely, lymphomas. It is important to suggest the diagnosis of peritoneal mesothelioma because special stains and electron microscopy are necessary for pathologic diagnosis. Experience suggests that CT may be useful in suggesting the diagnosis and biopsy site, and after response to therapy of peritoneal mesothelioma.

In plain English

This article described what peritoneal mesothelioma looks like on computed tomography (CT) scans, using a small case series. The authors reviewed abdominal CT scans of eight patients, seven men and one woman aged 42 to 71, whose peritoneal mesothelioma had been confirmed by tissue examination. Fourteen scans were evaluated in total. The article does not report these patients' asbestos exposure. On the first scans, seven of the eight patients showed thickening and irregularity of the peritoneum. The eighth had a normal scan but was found at surgery one month later to have diffuse tumor. Six of the eight patients had involvement of the mesentery. Ascites was seen on the initial scan in six of seven patients. Three patients had pleural effusions on the original scans, and two had tumor spread to a lumbar vertebra. The authors concluded that thickened peritoneum, ascites and involvement of the mesentery and omentum on CT should suggest peritoneal mesothelioma. They noted that ovarian cancer and spread of colon cancer can produce similar findings, usually with less severe peritoneal thickening. Chest CT was not performed.

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: case series: review of abdominal CT scans of patients with peritoneal mesothelioma (14 scans in 8 patients)
• Who was studied: 8 patients (7 men, 1 woman) aged 42 to 71 years (mean 55) with histologically proven peritoneal mesothelioma; diagnosed by exploratory laparotomy in seven and by laparoscopy with biopsy in one
• Main results:
  • On the original scans, seven of the eight patients had thickening and areas of peritoneal irregularity
  • One patient had a normal scan but was found at surgery 1 month later to have diffuse peritoneal and abdominal tumor involvement
  • Three of the seven patients had a nodular appearance of the peritoneum at the time of diagnosis
  • Six of the eight patients had involvement of the mesentery: two showed a pleated, thickened appearance and four showed a stellate configuration
  • Six of the seven patients had ascites on their initial scan, and one more developed ascites on a repeat scan
  • Three patients had pleural effusions on the original scans, and one more developed an effusion on a follow-up scan
  • Two patients had metastatic bone involvement, each involving a single lumbar vertebra
  • One patient had metastatic disease to the liver found at laparotomy; the remaining seven patients had no evidence of liver involvement
• The authors' conclusion: The authors concluded that CT findings of thickened peritoneum, ascites, and involvement of the mesentery and omentum should suggest peritoneal mesothelioma
• Limitations the authors state:
  • Chest CT scans were not performed; only the pleural spaces just above the diaphragm were seen, in seven of the eight patients
  • Ovarian carcinoma can show all these findings, though peritoneal thickening is usually less severe
  • Carcinomatosis from colon cancer may also mimic these findings
  • The stellate mesenteric appearance is not specific to mesothelioma

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Peritoneum, Mesentery, Ascites, Carcinoma, Biopsy.

Related studies

• Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases — U. Raju, G. Fine, et al. (1989)
• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)
• CT imaging of peritoneal carcinomatosis and its mimics — A.D. Diop, M. Fontarensky, et al. (2014)
• CT findings and serum ca 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature — M. Kebapci, E. Vardareli, et al. (2003)
• Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis — J.D. Rivard, W.J. Temple, et al. (2014)
• Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up — P.J. Guest, R.H. Reznek, et al. (1992)

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