DOI: 10.1148/rg.254045140
Primary Neoplasms of Peritoneal and Sub-peritoneal Origin: CT Findings1
Perry J. Pickhardt, MD and
Sanjeev Bhalla, MD
1 From the Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792 (P.J.P.); the Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (P.J.P.); and the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.). Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received June 30, 2004; revision requested September 21 and received October 6; accepted October 7. P.J.P. is a medical consultant for Viatronix, Inc; S.B. has no financial relationships to disclose.
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Figure 1. Malignant peritoneal mesothelioma. Contrast material–enhanced CT scan shows confluent peritoneum-based masses of varying attenuation that scallop the liver.
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Figure 2. Contrast-enhanced CT scan shows relatively uniform and diffuse thickening of both the visceral and parietal (arrowheads) peritonea with associated ascites. Omental infiltration is present, but no bulky masses or loculated fluid collections are seen.
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Figure 3a. Cystic mesothelioma in a young woman. CT scans (a obtained cephalad to b) show a large, peritoneum-based multilocular cystic mass. Note the thin cyst walls. No prominent soft-tissue component is present.
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Figure 3b. Cystic mesothelioma in a young woman. CT scans (a obtained cephalad to b) show a large, peritoneum-based multilocular cystic mass. Note the thin cyst walls. No prominent soft-tissue component is present.
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Figure 4. Primary papillary serous carcinoma of the peritoneum. Contrast-enhanced CT scan obtained in a middle-aged woman shows irregular soft-tissue infiltration of the omentum (arrows). No ovarian mass was present. The diagnosis was confirmed at ultrasonography-guided biopsy.
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Figure 5. Primary papillary serous carcinoma of the peritoneum. Contrast-enhanced CT scan obtained in a different middle-aged woman shows a solid mass involving the right aspect of the omentum (arrow). Note the small amount of adjacent peritoneal fluid and the prominent omental vessel. As in Figure 4, no ovarian mass was present.
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Figure 6. Metastatic papillary serous ovarian carcinoma. CT scan (bone window) shows densely calcified peritoneum-based metastases, which are considerably higher in attenuation than contrast material in the bowel. Primary peritoneal papillary carcinoma could have an identical appearance.
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Figure 7a. Desmoplastic small round cell tumor. Axial contrast-enhanced CT scans (a obtained cephalad to b) show multiple rounded peritoneum-based masses, which represent the most frequent manifestation of this disease.
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Figure 7b. Desmoplastic small round cell tumor. Axial contrast-enhanced CT scans (a obtained cephalad to b) show multiple rounded peritoneum-based masses, which represent the most frequent manifestation of this disease.
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Figure 8. Desmoplastic small round cell tumor. Axial contrast-enhanced CT scan shows diffuse peritoneal thickening with omental caking, findings that represent a less frequent manifestation of desmoplastic small round cell tumor.
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Figure 9. Lymphangioma. Contrast-enhanced CT scan shows a low-attenuation cystic lesion involving the gastrohepatic ligament (arrowheads). Note the vessel coursing between locules of the lesion.
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Figure 10. Mesenteric lymphangioma. Contrast-enhanced CT scan shows a large, low-attenuation cystic lesion involving the small bowel mesentery. Note the vessels coursing through the lesion (cf Fig 9).
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Figure 11. Mesenteric hemangioma. Contrast-enhanced CT scan shows a poorly circumscribed mesenteric soft-tissue mass (arrow) with punctate calcifications that represent phleboliths.
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Figure 12. Mesenteric lipoma. Contrast-enhanced CT scan shows a well-circumscribed lesion with uniform fat attenuation (arrowheads). No soft-tissue component is present.
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Figure 13. Plexiform neurofibroma in NF-1. Contrast-enhanced CT scan shows confluent low-attenuation material surrounding the superior mesenteric and replaced right hepatic arteries, a finding that represents a plexiform neurofibroma. Contiguous involvement of the retroperitoneum underscores the continuity of the retroperitoneum with the subperitoneal space.
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Figure 14. Multiple neurofibromas in NF-1. Contrast-enhanced CT scan shows a prominent low-attenuation mass near the root of the mesentery that surrounds the superior mesenteric vessels. Lymphadenopathy could also have this appearance; note, however, the presence of low-attenuation neurofibromas involving the paraspinal nerve roots (arrows).
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Figure 15a. Leiomyomatosis peritonealis disseminata in a woman with acute abdominal symptoms from cecal volvulus. Contrast-enhanced CT scans incidentally show several enhancing peritoneum-based nodules (arrowheads in a and b). Note also the multiple pedunculated subserosal uterine fibroids. Leiomyomatosis peritonealis disseminata was proved at subsequent laparotomy for cecal volvulus.
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Figure 15b. Leiomyomatosis peritonealis disseminata in a woman with acute abdominal symptoms from cecal volvulus. Contrast-enhanced CT scans incidentally show several enhancing peritoneum-based nodules (arrowheads in a and b). Note also the multiple pedunculated subserosal uterine fibroids. Leiomyomatosis peritonealis disseminata was proved at subsequent laparotomy for cecal volvulus.
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Figure 15c. Leiomyomatosis peritonealis disseminata in a woman with acute abdominal symptoms from cecal volvulus. Contrast-enhanced CT scans incidentally show several enhancing peritoneum-based nodules (arrowheads in a and b). Note also the multiple pedunculated subserosal uterine fibroids. Leiomyomatosis peritonealis disseminata was proved at subsequent laparotomy for cecal volvulus.
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Figure 16a. Mesenteric liposarcoma. Contrast-enhanced CT scans (a obtained cephalad to b) show a mesenteric lesion (arrowheads) that is predominantly fatty but contains heterogeneous soft-tissue elements.
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Figure 16b. Mesenteric liposarcoma. Contrast-enhanced CT scans (a obtained cephalad to b) show a mesenteric lesion (arrowheads) that is predominantly fatty but contains heterogeneous soft-tissue elements.
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Figure 17. Malignant fibrous histiocytoma. Contrast-enhanced CT scan shows a large, heterogeneous soft-tissue mass, which is a typical appearance of peritoneal malignant fibrous histiocytoma.
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Figure 18. Malignant fibrous histiocytoma. Contrast-enhanced CT scan shows a relatively small mesenteric tumor (arrowhead), which is an uncommon appearance of peritoneal malignant fibrous histiocytoma.
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Figure 19. Leiomyosarcoma. Axial contrast-enhanced CT scan shows a large, peritoneum-based soft-tissue mass with heterogeneous enhancement.
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Figure 20. GIST. Contrast-enhanced CT scan shows a large, heterogeneous omentum-based mass, a finding that was believed to represent a primary peritoneal tumor.
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Figure 21a. GIST complicating NF-1 in a patient who was referred for preoperative staging of "ovarian cancer." Contrast-enhanced CT scans show a large, heterogeneous midline abdominal mass (arrows in a) with a large cystic component extending inferiorly (* in b). Additional findings in NF-1 include mesenchymal dysplasia of the lumbar spine with an associated lateral meningocele (black arrowhead in a) and multiple cutaneous neurofibromas (white arrowheads). Given the CT findings, a diagnosis of malignant nerve sheath tumor or GIST rather than ovarian primary tumor was made, and the surgical approach was altered accordingly.
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Figure 21b. GIST complicating NF-1 in a patient who was referred for preoperative staging of "ovarian cancer." Contrast-enhanced CT scans show a large, heterogeneous midline abdominal mass (arrows in a) with a large cystic component extending inferiorly (* in b). Additional findings in NF-1 include mesenchymal dysplasia of the lumbar spine with an associated lateral meningocele (black arrowhead in a) and multiple cutaneous neurofibromas (white arrowheads). Given the CT findings, a diagnosis of malignant nerve sheath tumor or GIST rather than ovarian primary tumor was made, and the surgical approach was altered accordingly.
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Figure 22. Inflammatory fibrosarcoma in a young patient. CT scan shows a large, peritoneum-based mass with heterogeneous enhancement. Differentiation from inflammatory pseudotumor can be difficult at both imaging and pathologic evaluation in such cases.
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Figure 23. Angiosarcoma. Axial contrast-enhanced CT scan shows a large, complex cystic or necrotic mass involving the omentum. Angiosarcoma was subsequently proved at pathologic evaluation.
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Figure 24a. Synovial sarcoma. CT scans show a complex cystic-solid mass (arrowheads in a) centered in the gastrocolic ligament between the greater curve of the stomach and the transverse colon. Tumor calcification is also present, a finding that is unusual in peritoneal sarcomas.
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Figure 24b. Synovial sarcoma. CT scans show a complex cystic-solid mass (arrowheads in a) centered in the gastrocolic ligament between the greater curve of the stomach and the transverse colon. Tumor calcification is also present, a finding that is unusual in peritoneal sarcomas.
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Figure 25. Peritoneal lymphomatosis. Contrast-enhanced CT scan shows omental soft-tissue infiltration and ascites. No organ-based primary site was identified. Omental lymphoma was diagnosed at ultrasonography-guided biopsy.
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Figure 26. Peritoneal lymphomatosis. Contrast-enhanced CT scan shows extensive peritoneal soft-tissue infiltration with omental caking and diffuse mesenteric thickening. Note also the presence of lymphadenopathy (arrowheads).
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Figure 27a. Leukemic infiltration in a woman with acute lymphocytic leukemia. Contrast-enhanced CT scans show diffuse, irregular peritoneal thickening (arrowheads) and ascites. Uterine involvement is also present (* in b).
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Figure 27b. Leukemic infiltration in a woman with acute lymphocytic leukemia. Contrast-enhanced CT scans show diffuse, irregular peritoneal thickening (arrowheads) and ascites. Uterine involvement is also present (* in b).
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Figure 28. Granulocytic sarcoma (chloroma). Contrast-enhanced CT scan obtained in a patient with acute myelogenous leukemia shows extramedullary peritoneal involvement consisting of a focal mesenteric mass in the ileocecal region (arrow).
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Figure 29. Granulocytic sarcoma (chloroma). Contrast-enhanced CT scan obtained in a different patient with acute myelogenous leukemia shows extensive and diffuse peritoneal involvement.
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Figure 30a. Extramedullary plasmacytomas in a patient with known multiple myeloma. Contrast-enhanced CT scans (a obtained cephalad to b) show multiple peritoneal and retroperitoneal soft-tissue masses. Renal, adrenal, and pancreatic involvement are also seen.
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Figure 30b. Extramedullary plasmacytomas in a patient with known multiple myeloma. Contrast-enhanced CT scans (a obtained cephalad to b) show multiple peritoneal and retroperitoneal soft-tissue masses. Renal, adrenal, and pancreatic involvement are also seen.
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Copyright © 2005 by the Radiological Society of North America.
