AFIP Archives - From the Archives of the AFIP

Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation

Published Online:https://doi.org/10.1148/rg.292085189

Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphomas and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions.

References

  • 1 MeyersMA, Oliphant M, Berne AS, Feldberg MA. The peritoneal ligaments and mesenteries: pathways of intraabdominal spread of disease. Radiology1987; 163: 593–604.
  • 2 FeldmanGB, Knapp RC. Lymphatic drainage of the peritoneal cavity and its significance in ovarian cancer. Am J Obstet Gynecol1974; 119: 991–994.
  • 3 MeyersMA. Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium Ther Nucl Med1973; 119: 198–206.
  • 4 MeyersMA. Peritoneography: normal and pathologic anatomy. Am J Roentgenol Radium Ther Nucl Med1973; 117: 353–365.
  • 5 MeyersMA. Dynamic radiology of the abdomen: normal and pathologic anatomy. New York, NY: Springer, 2000.
  • 6 LevyAD, Arnáiz J, Shaw JC, Sobin LH. Primary peritoneal tumors: imaging features with pathologic correlation. RadioGraphics2008; 28: 583–607.
  • 7 ChuDZ, Lang NP, Thompson C, Osteen PK, West-brook KC. Peritoneal carcinomatosis in nongynecologic malignancy: a prospective study of prognostic factors. Cancer1989; 63: 364–367.
  • 8 SadeghiB, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer2000; 88: 358–363.
  • 9 HanbidgeAE, Lynch D, Wilson SR. US of the peritoneum. RadioGraphics2003; 23: 663–684; discussion 684–685.
  • 10 YehHC. Ultrasonography of peritoneal tumors. Radiology1979; 133: 419–424.
  • 11 WalkeyMM, Friedman AC, Sohotra P, Radecki PD. CT manifestations of peritoneal carcinomatosis. AJR Am J Roentgenol1988; 150: 1035–1041.
  • 12 JacquetP, Jelinek JS, Steves MA, Sugarbaker PH. Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer1993; 72: 1631–1636.
  • 13 Hamrick-TurnerJE, Chiechi MV, Abbitt PL, Ros PR. Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT. RadioGraphics1992; 12: 1051–1068.
  • 14 WhitleyNO, Bohlman ME, Baker LP. CT patterns of mesenteric disease. J Comput Assist Tomogr1982; 6: 490–496.
  • 15 LowRN. MR imaging of the peritoneal spread of malignancy. Abdom Imaging2007; 32: 267–283.
  • 16 de BreeE, Koops W, Kroger R, van Ruth S, Witkamp AJ, Zoetmulder FA. Peritoneal carcinomatosis from colorectal or appendiceal origin: correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol2004; 86: 64–73.
  • 17 CoakleyFV, Choi PH, Gougoutas CA, et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology2002; 223: 495–499.
  • 18 LowRN, Barone RM, Lacey C, Sigeti JS, Alzate GD, Sebrechts CP. Peritoneal tumor: MR imaging with dilute oral barium and intravenous gadolinium-containing contrast agents compared with unenhanced MR imaging and CT. Radiology1997; 204: 513–520.
  • 19 PannuHK, Bristow RE, Cohade C, Fishman EK, Wahl RL. PET-CT in recurrent ovarian cancer: initial observations. RadioGraphics2004; 24: 209–223.
  • 20 TanakaT, Kawai Y, Kanai M, Taki Y, Nakamoto Y, Takabayashi A. Usefulness of FDG-positron emission tomography in diagnosing peritoneal recurrence of colorectal cancer. Am J Surg2002; 184: 433–436.
  • 21 TurlakowA, Yeung HW, Salmon AS, Macapinlac HA, Larson SM. Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med2003; 44: 1407–1412.
  • 22 BradleyRF, Stewart JH, Russell GB, Levine EA, Geisinger KR. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Am J Surg Pathol2006; 30: 551–559.
  • 23 CarrNJ, Arends MJ, Deans GT, Sobin LH. Adenocarcinoma of the appendix. In: Aaltonen LA, Hamilton SR, eds. World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon, France: IARC, 2000; 95–102.
  • 24 RonnettBM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis: a clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol1995; 19: 1390–1408.
  • 25 PaiRK, Longacre TA. Pseudomyxoma peritonei syndrome: classification of appendiceal mucinous tumours. In: Ceelen WP, ed. Peritoneal carcinomatosis: a multidisciplinary approach. New York, NY: Springer, 2007; 71–107.
  • 26 MoranBJ, Cecil TD. The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin N Am2003; 12: 585–603.
  • 27 Fenoglio-PreiserCM. Gastrointestinal pathology: an atlas and text. Philadelphia, Pa: Wolters Kluwer/Lippincott Williams & Wilkins, 2008.
  • 28 SeidmanJD, Elsayed AM, Sobin LH, Tavassoli FA. Association of mucinous tumors of the ovary and appendix: a clinicopathologic study of 25 cases. Am J Surg Pathol1993; 17: 22–34.
  • 29 YoungRH, Gilks CB, Scully RE. Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei: a clinicopathological analysis of 22 cases supporting an origin in the appendix. Am J Surg Pathol1991; 15: 415–429.
  • 30 YoungRH. Pseudomyxoma peritonei and selected other aspects of the spread of appendiceal neoplasms. Semin Diagn Pathol2004; 21: 134–150.
  • 31 SugarbakerPH. Pseudomyxoma peritonei: a cancer whose biology is characterized by a redistribution phenomenon. Ann Surg1994; 219: 109–111.
  • 32 BattiforaH, McCaughey WTE. Tumors of the serosal membranes. Washington, DC: Armed Forces Institute of Pathology, 1995.
  • 33 HellmerH. Die konturen des rechten leberlappens beim ascites. Acta Radiol1942; 23: 533–540.
  • 34 MillerDL, Udelsman R, Sugarbaker PH. Calcification of pseudomyxoma peritonei following intraperitoneal chemotherapy: CT demonstration. J Comput Assist Tomogr1985; 9: 1123–1124.
  • 35 SulkinTV, O’Neill H, Amin AI, Moran B. CT in pseudomyxoma peritonei: a review of 17 cases. Clin Radiol2002; 57: 608–613.
  • 36 YehHC, Shafir MK, Slater G, Meyer RJ, Cohen BA, Geller SA. Ultrasonography and computed tomography in pseudomyxoma peritonei. Radiology1984; 153: 507–510.
  • 37 SeshulMB, Coulam CM. Pseudomyxoma peritonei: computed tomography and sonography. AJR Am J Roentgenol1981; 136: 803–806.
  • 38 BechtoldRE, Chen MY, Loggie BW, Jackson SL, Geisinger K. CT appearance of disseminated peritoneal adenomucinosis. Abdom Imaging2001; 26: 406–410.
  • 39 SugarbakerPH, Ronnett BM, Archer A, et al. Pseudomyxoma peritonei syndrome. Adv Surg1996; 30: 233–280.
  • 40 PestieauSR, Esquivel J, Sugarbaker PH. Pleural extension of mucinous tumor in patients with pseudomyxoma peritonei syndrome. Ann Surg Oncol2000; 7: 199–203.
  • 41 NadorRG, Cesarman E, Chadburn A, et al. Primary effusion lymphoma: a distinct clinicopathologic entity associated with the Kaposi’s sarcoma-associated herpes virus. Blood1996; 88: 645–656.
  • 42 BanksPM, Warnke RA. Primary effusion lymphoma. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization classification of tumours: pathology and genetics of tumours of the haematopoietic and lymphoid tissue. Lyon, France: IARC, 2001; 179–180.
  • 43 KimY, Cho O, Song S, Lee H, Rhim H, Koh B. Peritoneal lymphomatosis: CT findings. Abdom Imaging1998; 23: 87–90.
  • 44 LynchMA, Cho KC, Jeffrey RB Jr, Alterman DD, Federle MP. CT of peritoneal lymphomatosis. AJR Am J Roentgenol1988; 151: 713–715.
  • 45 FerrozziF, Tognini G, Mulonzia NW, Bova D, Pavone P. Primary effusion lymphomas in AIDS: CT findings in two cases. Eur Radiol2001; 11: 623–625.
  • 46 MorassutS, Vaccher E, Balestreri L, et al. HIV-associated human herpesvirus 8-positive primary lymphomatous effusions: radiologic findings in six patients. Radiology1997; 205: 459–463.
  • 47 ZanariniD, Sugarbaker PH. Extremity soft tissue sarcoma with metastases to abdominopelvic surfaces. J Surg Oncol1997; 64: 68–72; discussion 72–73.
  • 48 DeMatteoRP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg2000; 231: 51–58.
  • 49 LevyAD. Imaging and staging of gastrointestinal stromal tumors. In: Jankowski JAZ, ed. Gastrointestinal oncology: a critical multidisciplinary team approach. Oxford, England: Blackwell, 2008; 240–244.
  • 50 HaddadFS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum1987; 30: 724–735.
  • 51 EpsteinBM, Mann JH. CT of abdominal tuberculosis. AJR Am J Roentgenol1982; 139: 861–866.
  • 52 HaHK, Jung JI, Lee MS, et al. CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. AJR Am J Roentgenol1996; 167: 743–748.
  • 53 AltermanDD, Cho KC. Histoplasmosis involving the omentum in an AIDS patient: CT demonstration. J Comput Assist Tomogr1988; 12: 664–665.
  • 54 DayDL, Sane S, Dehner LP. Inflammatory pseudotumor of the mesentery and small intestine. Pediatr Radiol1986; 16: 210–215.
  • 55 CoffinCM, Watterson J, Priest JR, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor): a clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol1995; 19: 859–872.
  • 56 GleasonBC, Hornick JL. Inflammatory myofibroblastic tumours: where are we now? J Clin Pathol2008; 61: 428–437.
  • 57 LevyAD, Rimola J, Mehrotra AK, Sobin LH. Benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation. RadioGraphics2006; 26: 245–264.
  • 58 NarlaLD, Newman B, Spottswood SS, Narla S, Kolli R. Inflammatory pseudotumor. RadioGraphics2003; 23: 719–729.
  • 59 HollmanAS, McMillan MA, Briggs JD, Junor BJ, Morley P. Ultrasound changes in sclerosing peritonitis following continuous ambulatory peritoneal dialysis. Clin Radiol1991; 43: 176–179.
  • 60 GeorgeC, Al-Zwae K, Nair S, Cast JE. Computed tomography appearances of sclerosing encapsulating peritonitis. Clin Radiol2007; 62: 732–737.
  • 61 WoodwardPJ, Sohaey R, Mezzetti TP Jr. Endometriosis: radiologic-pathologic correlation. RadioGraphics2001; 21: 193–216.
  • 62 OliveDL, Schwartz LB. Endometriosis. N Engl J Med1993; 328: 1759–1769.
  • 63 ClementPB. Endometriosis, lesions of the secondary mullerian system, and pelvic mesothelial proliferations. In: Kurman RJ, ed. Blaustein’s pathology of the female genital tract. 5th ed. New York, NY: Springer, 2002; 729–789.
  • 64 SternRC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol2001; 20: 133–139.
  • 65 ArriveL, Hricak H, Martin MC. Pelvic endometriosis: MR imaging. Radiology1989; 171: 687–692.
  • 66 BazotM, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology2004; 232: 379–389.
  • 67 HaHK, Lim YT, Kim HS, Suh TS, Song HH, Kim SJ. Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images. AJR Am J Roentgenol1994; 163: 127–131.
  • 68 SugimuraK, Okizuka H, Imaoka I, et al. Pelvic endometriosis: detection and diagnosis with chemical shift MR imaging. Radiology1993; 188: 435–438.
  • 69 AscherSM, Agrawal R, Bis KG, et al. Endometriosis: appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques. J Magn Reson Imaging1995; 5: 251–257.
  • 70 LovellMA, Ross GW, Cooper PH. Gliomatosis peritonei associated with a ventriculoperitoneal shunt. Am J Clin Pathol1989; 91: 485–487.
  • 71 MullerAM, Sondgen D, Strunz R, Muller KM. Gliomatosis peritonei: a report of two cases and review of the literature. Eur J Obstet Gynecol Reprod Biol2002; 100: 213–222.
  • 72 FergusonAW, Katabuchi H, Ronnett BM, Cho KR. Glial implants in gliomatosis peritonei arise from normal tissue, not from the associated teratoma. Am J Pathol2001; 159: 51–55.
  • 73 OkamotoD, Ishigami K, Yoshimitsu K, et al. Gliomatosis peritonei associated with immature ovarian teratoma: a mimicker of peritoneal dissemination of malignant diseases. J Comput Assist Tomogr2007; 31: 317–319.
  • 74 EnglandRA, deSouza NM, Kaye SB. Gliomatosis peritonei: MRI appearances and its potential role in follow up. Br J Radiol2007; 80: e101–104.
  • 75 FadareO, Bifulco C, Carter D, Parkash V. Cartilaginous differentiation in peritoneal tissues: a report of two cases and a review of the literature. Mod Pathol2002; 15: 777–780.
  • 76 PatelRM, Weiss SW, Folpe AL. Heterotopic mesenteric ossification: a distinctive pseudosarcoma commonly associated with intestinal obstruction. Am J Surg Pathol2006; 30: 119–122.
  • 77 WilsonJD, Montague CJ, Salcuni P, Bordi C, Rosai J. Heterotopic mesenteric ossification (“intraabdominal myositis ossificans”): report of five cases. Am J Surg Pathol1999; 23: 1464–1470.
  • 78 HakimM, McCarthy EF. Heterotopic mesenteric ossification. AJR Am J Roentgenol2001; 176: 260–261.
  • 79 ToninoBA, van der Meulen HG, Kuijpers KC, Mallens WM, van Gils AP. Heterotropic mesenteric ossification: a case report (2004:10b). Eur Radiol2005; 15: 195–197.
  • 80 JaworskiRC, Boadle R, Greg J, Cocks P. Peritoneal “melanosis” associated with a ruptured ovarian dermoid cyst: report of a case with electron-probe energy dispersive X-ray analysis. Int J Gynecol Pathol2001; 20: 386–389.
  • 81 KimNR, Suh YL, Song SY, Ahn G. Peritoneal melanosis combined with serous cystadenoma of the ovary: a case report and literature review. Pathol Int2002; 52: 724–729.
  • 82 De la Torre MondragonL, Daza DC, Bustamante AP, Fascinetto GV. Gastric triplication and peritoneal melanosis. J Pediatr Surg1997; 32: 1773–1775.
  • 83 FukushimaM, Sharpe L, Okagaki T. Peritoneal melanosis secondary to a benign dermoid cyst of the ovary: a case report with ultrastructural study. Int J Gynecol Pathol1984; 2: 403–409.
  • 84 JungYC, Chen CJ, Tzeng CC. Melanosis peritonei associated with enteric duplication cyst: a case report. Am J Surg Pathol1996; 20: 181–186.
  • 85 FlemingCR, Dickson ER, Harrison EG Jr. Splenosis: autotransplantation of splenic tissue. Am J Med1976; 61: 414–419.
  • 86 BrewsterDC. Splenosis: report of two cases and review of the literature. Am J Surg1973; 126: 14–19.
  • 87 MaillardJC, Menu Y, Scherrer A, Witz MO, Nahum H. Intraperitoneal splenosis: diagnosis by ultrasound and computed tomography. Gastrointest Radiol1989; 14: 179–180.
  • 88 BrancatelliG, Vilgrain V, Zappa M, Lagalla R. Case 80: splenosis. Radiology2005; 234: 728–732.
  • 89 MendelsonDS, Cohen BA, Armas RR. CT appearance of splenosis. J Comput Assist Tomogr1982; 6: 1188–1190.
  • 90 GentryLR, Brown JM, Lindgren RD. Splenosis: CT demonstration of heterotopic autotransplantation of splenic tissue. J Comput Assist Tomogr1982; 6: 1184–1187.
  • 91 LinWC, Lee RC, Chiang JH, et al. MR features of abdominal splenosis. AJR Am J Roentgenol2003; 180: 493–496.
  • 92 AlvarezR, Diehl KM, Avram A, Brown R, Piert M. Localization of splenosis using 99mTc-damaged red blood cell SPECT/CT and intraoperative gamma probe measurements. Eur J Nucl Med Mol Imaging2007; 34: 969.
  • 93 FranceschettoA, Casolo A, Cucca M, Bagni B. Splenosis: 99mTc-labelled colloids provide the diagnosis in splenectomised patients. Eur J Nucl Med Mol Imaging2006; 33: 1102.

Article History

Published in print: Mar 2009