Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2020; 12(12): 316-326
Published online Dec 28, 2020. doi: 10.4329/wjr.v12.i12.316
Unusual radiologic presentations of malignant peritoneal mesothelioma
Paul Hendrick Sugarbaker, James S Jelinek
Paul Hendrick Sugarbaker, Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States
James S Jelinek, Department of Radiology, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Sugarbaker PH and Jelinek JS contributed study concepts, study design, data acquisition, quality control of data and algorithms, data analysis and interpretation, and manuscript preparation and review.
Institutional review board statement: This study of peritoneal carcinomatosis has been active as a quality improvement project for 26 years. The initial approval to begin preparation of a manuscript in 2015 is included with this article submission. Subsequent extensions of this permission have been requested and can be made available if necessary to fulfill the Editors’ requirements.
Informed consent statement: Patients were not required to give informed consent because this was a retrospective study and used anonymous patient data.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Upon request, data in the article will be shared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paul Hendrick Sugarbaker, FACS, FRCS (Hon), MD, Surgical Oncologist, Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, 106 Irving St. NW Suite 3900, Washington, DC 20010, United States. paul.sugarbaker@outlook.com
Received: March 26, 2020
Peer-review started: March 26, 2020
First decision: October 21, 2020
Revised: November 4, 2020
Accepted: November 28, 2020
Article in press: November 28, 2020
Published online: December 28, 2020
Abstract
BACKGROUND

Malignant peritoneal mesothelioma is an unusual disease process characterized radiologically by ascites and infiltration of the peritoneum by multiple small tumor nodules. Both parietal and visceral peritoneum are involved by the multiple malignant tumor nodules. Computed tomography (CT) has been used to identify the anatomic pathology induced by the progression of this malignant process.

AIM

To identify and then describe unusual CT images in patients with malignant peritoneal mesothelioma. Recognition of these unusual radiologic findings can cause the radiologist to be suspicious of this rare malignant process.

METHODS

In 100 patients who were to undergo definitive treatment of malignant peritoneal mesothelioma, the findings on preoperative CT scans were catalogued. Many of these changes were repeatedly noted on the CT scans. Other pathologic CT images were less common. These unusual radiologic presentations were specially studied in this manuscript.

RESULTS

Eight unusual radiologic presentations of malignant peritoneal mesothelioma were selected for study. These unusual findings included a mass occurring within a Spigelian hernia, infiltration of the splenic parenchyma by spherical mesothelioma masses, infiltration of the lower mediastinum by tumor, a mesothelioma mass within a left inguinal canal, enlarged cardiophrenic angle lymph nodes, pleural plaques associated with the progression of malignant peritoneal mesothelioma, splenic notches caused by disease surrounding the spleen, and a mass greater than 5 cm associated with the proximal jejunum and directly adjacent to the anatomic location of the Treitz ligament.

CONCLUSION

There are unusual radiologic presentations of malignant peritoneal mesothelioma that are important to recognize in order to accurately diagnose this disease by CT.

Keywords: Costophrenic angle lymph nodes, Pleural plaques, Inguinal mass, Inguinal hernia mass, Splenic notches, Concerning computed tomography features

Core Tip: Malignant peritoneal mesothelioma is an unusual disease process characterized radiologically by ascites and infiltration of the peritoneum by multiple small tumor nodules. Both parietal and visceral peritoneum are involved by the multiple malignant tumor nodules. There are unusual radiologic presentations of malignant peritoneal mesothelioma that are important to recognize in order to accurately diagnose this disease by computed tomography.