Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT

Our plain-English summary of Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT, by J.E. Hamrick-Turner, M.V. Chiechi, P.L. Abbitt, et al (Radiographics, 1992).

The study

• Authors: J.E. Hamrick-Turner, M.V. Chiechi, P.L. Abbitt, P.R. Ros
• Journal: Radiographics
• Published: 1992;12(6):1051-68
• Type of article: Review
• Cited by: 88 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Disease processes in the peritoneum, omentum, and mesentery occasionally are not recognized at radiologic examination. The authors have used computed tomography (CT) to categorize the radiologic appearances of the more common abnormalities into three basic patterns: (a) solid but relatively well-defined masses, (b) cystic-appearing masses, and (c) ill-defined or infiltrative processes. The most common solid masses to affect these anatomic regions are secondary neoplasms, which are associated with enhancement of the peritoneum on contrast material-enhanced CT scans and, typically, ascites. The various cystic-appearing masses (including cystic lymphangioma, cystic mesothelioma, teratoma, and loculated ascites) and infiltrating masses (such as peritoneal mesothelioma, retractile mesenteritis, desmoid, and carcinoid) must be differentiated on the basis of clinical findings and additional imaging findings (eg, CT depiction of fat and calcium in teratomas and the radiating appearance of carcinoids). Although the CT appearances of some of the abnormalities overlap, classifying them by pattern is helpful in narrowing the range of the differential diagnosis.

In plain English

This article was a review by radiologists from the University of Florida of how diseases of the peritoneum (the lining of the abdominal cavity), the omentum and the mesentery look on CT scans. It did not study a defined group of patients or measure asbestos exposure. It described imaging features and illustrated them with scans of individual patients. The authors sorted the appearances into three patterns: solid masses, cystic-appearing masses, and ill-defined or infiltrative processes. Citing earlier publications, they described peritoneal mesothelioma as an uncommon tumor associated with asbestos exposure, and cystic mesothelioma as a rare benign tumor with no association with asbestos. They wrote that peritoneal mesothelioma may show nodular peritoneal or omental masses in early disease, can produce an infiltrative pattern in the mesentery, and usually features minimal ascites (abdominal fluid). Cystic mesothelioma, by contrast, has a cystic appearance. Several conditions, including peritoneal mesothelioma, may look similar on CT, and many cases ultimately require a biopsy or fluid sampling. The authors concluded that this pattern approach, combined with clinical information, should help radiologists narrow the range of possible diagnoses considerably.

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: Review of CT (and some ultrasound) appearances of peritoneal, omental and mesenteric diseases, using a pattern approach and illustrated with individual cases
• Who was studied: No defined study population or patient count. The article was written by the Department of Radiology, University of Florida, and illustrated with CT and ultrasound images of individual patients (for example, a 6-year-old boy with peritoneal mesothelioma).
• Exposure: Asbestos exposure was not studied. It was mentioned only as background from cited literature: peritoneal mesothelioma is described as associated with asbestos exposure, and cystic mesothelioma as having no association with asbestos.
• Main results:
  • The authors grouped CT appearances into three patterns: solid, cystic and infiltrative.
  • Citing earlier literature, the authors stated that cystic mesothelioma, a rare benign tumor, has no association with asbestos exposure.
  • Peritoneal mesothelioma: in early disease, imaging shows nodular peritoneal or omental masses.
  • Malignant peritoneal mesothelioma can also produce an infiltrative pattern within the mesentery.
  • Peritoneal mesothelioma may appear as a solid mass with enhancing peritoneum but usually features minimal ascites.
  • Cystic mesothelioma appears as a nonspecific cystic mass on CT and ultrasound.
  • Infiltrative conditions, including peritoneal mesothelioma, may appear similar on CT.
  • Many of these conditions ultimately require biopsy or fluid sampling for diagnosis.
• The authors' conclusion: The authors concluded that using this pattern approach together with clinical information, the radiologist should be able to narrow the differential diagnosis considerably, if not actually provide a diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneum, Omentum, Mesentery, Neoplasm, CT Scan, Ascites, Mesothelioma, Peritoneal Mesothelioma.

Related studies

• Asbestos in extrapulmonary sites: omentum and mesentery — R.F. Dodson, M.F. O'Sullivan, et al. (2000)
• Asbestos content of omentum and mesentery in nonoccupationally exposed individuals — R.F. Dodson, M.F. O'Sullivan, et al. (2001)
• Inflammatory and neoplastic processes of the lung: differential diagnosis and pitfalls in FNA biopsies — J.F. Silverman (1995)
• Primary malignant mesothelioma of the greater omentum: report of a case — Y.C. Liu, Y.L. Kuo, et al. (2004)
• Mesothelial proliferation due to asbestos and man-made fibres. Experimental studies on rat omentum — J. Friemann, K.M. Müller, et al. (1990)
• Combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum — Y. Hatano, Y. Hirose, et al. (2011)

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