Malignant peritoneal mesothelioma - localized
Patient presents with a partial bowel obstruction and weight loss. She has a past history of a hysterectomy and bilateral oophorectomy over 20 years ago (indication for this is not evident)
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Magnetic resonance imaging (MRI) study showed a solid mass of about 7 cm x 5.3 cm x 5.6 cm in diameter, involving the upper the vaginal vault, with intermediate signal on T1, predominantly hypointense on T2-weighted sequences with small cystic areas / necrosis.
Administration of contrast shows heterogeneous enhancement, more intense in later stages. The mass has a restrictive pattern on diffusion sequences.
The mass demonstrates no cleavage plane with the rectosigmoid, which appears displaced and thick walled. There is poor definition in outline in relation to soft tissue adjacent to the right lateral wall of the pelvis. No enlarged lymph nodes in the pelvis.
Nor do we show lymphadenopathy in the retroperitoneum.
No free fluid in the pelvis displayed.
This study demonstrates a large pelvic mass with infiltration of adjacent organs and diffusion restriction indicating aggressiveness of the lesion. Because its large size is difficult to establish the exact anatomical origin. Possibilities include:
- ovarian or uterine neoplasm (unlikely with a history of hysterectomy and oophorectomy 20 years ago)
- rectosigmoid neoplasm
- mesenteric or peritoneal tumor (e.g. desmoid tumor, solitary fibrous tumor, leiomyosarcoma, malignant mesothelioma)
Since the mass has a slight enhancement after contrast administration, more evident in later stages, and GIST, the desmoid tumor, solitary fibrous tumor and leiomyosarcoma are hypervascular, with intense enhancement in the early stages, we favored a malignant peritoneal mesothelioma.
This was subsequently confirmed by histological study.
Acknowledgments: I'm grateful to Dra. M. Arias, Dr. A. Iglesias Castañón (GALARIA-Vigo)
- 1. Busch JM, Kruskal JB, Wu B et-al. Best cases from the AFIP. Malignant peritoneal mesothelioma. Radiographics. 22 (6): 1511-5. doi:10.1148/rg.226025125 - Pubmed citation
- 2. Levy AD, Arnáiz J, Shaw JC et-al. From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation. Radiographics. 28 (2): 583-607. doi:10.1148/rg.282075175 - Pubmed citation