Published online Dec 28, 2020. doi: 10.4329/wjr.v12.i12.316
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
Processing time: 276 Days and 19.3 Hours
Rare diseases are often associated with bad outcomes. Delay in diagnosis and a lack of understanding of the natural history of the rare disease may contribute to unnecessary suffering.
Malignant peritoneal mesothelioma is a rare malignancy that has treatment options that provide long-term benefit. Progression within the peritoneal space in the absence of a primary site creates a challenge to its identification and radiologic description.
To identify and then describe unusual computed tomography (CT) images in patients with malignant peritoneal mesothelioma. The unusual radiologic findings are to be described along with clinical information about an individual patient.
In the pretreatment CTs of 100 patients with malignant peritoneal mesothelioma the majority of patients showed ascites, an omental cake or mesentery infiltrated by tumor. The other clearly depicted unusual CT findings and their frequency were sought to construct this manuscript.
From the 100 pretreatment CTs, eight unusual CT findings were identified, the images reproduced for the reader and the clinical features of the patient described. 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.
We described eight unusual radiologic presentations of malignant peritoneal mesothelioma that are important to recognize in order to accurately diagnose this disease by CT.
The role of the radiologist in identification, description and prognosis assessment of malignancies associated with the peritoneum and peritoneal spaces is expanding. Familiarity with unusual CT findings in a rare peritoneal disease, malignant peritoneal mesothelioma, is a step toward this expanded role of the radiologist in patient management.