Recurrent malignant peritoneal mesothelioma: radiological manifestations

Our plain-English summary of Recurrent malignant peritoneal mesothelioma: radiological manifestations, by F.F. Souza, J. Jagganathan, N. Ramayia, et al (Abdominal Imaging, 2010).

The study

• Authors: F.F. Souza, J. Jagganathan, N. Ramayia, C. Johnston, D. Jackman, A.V. Abbeele, P.R. Ros
• Journal: Abdominal Imaging
• Published: 2010;35(3):315-21
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To describe the CT imaging findings of recurrent malignant peritoneal mesothelioma in patients who underwent debulking surgery.

Materials And Methods: The history, clinical and laboratory data, and imaging studies of 13 patients with histologically proven diagnosis of Malignant Peritoneal Mesothelioma (MPM) and their recurrence following cytoreductive surgery were reviewed. CT studies were reviewed for presence of ascites, peritoneal, mesenteric and omental involvement, presence of solid abdominal viscera involvement, gastrointestinal involvement, presence and location of enlarged lymph nodes and extra abdominal sites of involvement.

Results: The most common finding at recurrence was ascites (n = 6). Peritoneal thickening was seen in five patients, infiltration of the peritoneum resembling omental caking was seen in one patient, and low density implants mimicking pseudomyxoma peritonei was seen in another patient. None of the peritoneal implants showed calcification. Three patients had large discrete soft tissue masses in the omentum and/or peritoneum. Multifocal serosal implants were seen in four patients; one had low grade small bowel obstruction which was managed conservatively. Three patients had evidence of intrathoracic disease seen as soft tissue pericardial mass and malignant pleural effusions.

Conclusion: CT findings of recurrent MPM resemble primary MPM, metastatic or granulomatous diseases. Radiologist should be aware of its appearance and forms of recurrence which may be seen at extra abdominal sites.

In plain English

This study looked back at the CT scans of patients whose malignant peritoneal mesothelioma, a cancer of the lining of the abdomen, came back after debulking (cytoreductive) surgery. Of 22 consecutive patients with confirmed disease treated at the authors' institution from 1998 to 2008, the 13 who had this surgery were included. All 13 had the epithelial subtype. Two had a history of asbestos exposure, one of them from childhood exposure at home. The cancer came back a median of 7.5 months after surgery (range 1 to 20 months). Fluid in the abdomen (ascites) was the most common finding at recurrence, seen in six patients (46%). Five had thickening of the abdominal lining, three had separate masses, five had disease in the mesentery (the tissue holding the bowel), four had implants on the bowel or stomach surface, and three had masses in the chest. No calcification was seen. The authors concluded that recurrence takes varied forms and is mostly confined to the abdominal cavity. They noted that the study was retrospective and small, and that not every lesion was confirmed by tissue sampling.

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: Retrospective review (case series) of CT imaging, medical records and history
• Who was studied: Of 22 consecutive patients with histologically proven malignant peritoneal mesothelioma treated at the authors' institution from 1998 to 2008, 9 who did not have debulking surgery were excluded. That left 13 patients (7 women, 6 men; mean age 52 years; range 16 to 81 years), all with the epithelial subtype.
• Exposure: The study was about imaging after cytoreductive (debulking) surgery, not about asbestos dose. Two of the 13 patients had a prior history of asbestos exposure. No fiber types were reported.
• Main results:
  • Of the two exposed patients, one had childhood exposure to asbestos at home and developed peritoneal mesothelioma about 50 years later. The other was exposed in the early 1960s and developed the disease about 30 years later.
  • Across the 13 patients, the median time to recurrence after debulking surgery was 7.5 months (range 1 to 20 months).
  • Of the 13 patients, one died. Among patients still alive, the median disease duration was 20.9 months (range 3 to 51 months).
  • Ascites was the most common finding at recurrence, present in 6 of the 13 patients (46%). It was moderate in 3 and mild in 3.
  • Nodular thickening of the peritoneum was seen in 3 patients and smooth thickening in 2.
  • One patient had diffuse infiltration of the peritoneum resembling omental caking.
  • Three patients had discrete soft tissue mass-like lesions without thickening of the peritoneum.
  • No patient showed calcification.
  • The mesentery was involved in 5 of the 13 patients.
  • Serosal implants were seen in 4 patients. One patient had a low grade small bowel obstruction that resolved on its own.
  • Intrathoracic soft tissue masses were seen in 3 patients.
  • One patient developed a nodule in the abdominal wall at a prior port site. It was not confirmed by pathology, but its appearance suggested tumor seeding along the needle tract.
• The authors' conclusion: The authors concluded that CT findings of recurrent malignant peritoneal mesothelioma vary, that ascites is the most common finding, and that in most patients recurrence is confined to the peritoneal cavity. They said radiologists should be aware of these patterns of recurrence.
• Limitations the authors state:
  • The study was retrospective.
  • The number of patients was small, and not all lesions on restaging scans were confirmed by tissue examination.
  • All patients had the epithelial subtype, so imaging findings could not be compared with other subtypes.

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, Cytoreductive Surgery, Ascites, Omental Involvement, Peritoneum, Omental Caking, Omentum, Intrathoracic.

Related studies

• 18F-FDG PET/CT in a recurrent diffuse malignant peritoneal mesothelioma — Q. Cao, M. Lu, et al. (2012)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma — M.D. Llanos, P.H. Sugarbaker (2017)
• Recurrent peritoneal mesothelioma with long-delayed recurrence — A. Tandar, G. Abraham, et al. (2001)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

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