Radiologic Evaluation of Malignant Pleural and Peritoneal Mesothelioma

Malignant mesothelioma is an asbestos-associated malignancy arising from the mesothelial cells of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis.
Mesothelioma usually presents in the fifth to seventh decades, and 70-80 % of cases occur in men (Moore et al., 2008). Malignant pleural mesothelioma (MPM) is the most widely form of mesothelioma. Patients frequently present with dyspnea, chest pain, cough, and weight loss (Moore et al., 2008, Wang et al., 2004). Although most of the mesotheliomas cover the pleural surface, approximately 35% arise only from peritoneum. Patients with malignant peritoneal mesothelioma may present with abdominal pain, distention, anorexia, and weight loss (Park et al., 2008).
Radiologic modalities play a crucial role in the evaluation of malignant mesothelioma. Computed tomography is the primary imaging method used for the diagnosis and the staging of malignant mesothelioma, but also for guiding biopsy for tissue diagnosis.
Magnetic resonans imaging (MRI) is useful for detection of extension of disease, especially to the chest wall and diaphragm (Moore et al., 2008, Wang et al., 2004). In this article we review radiologic findings of malignant pleural and peritoneal mesothelioma with our patient archives. We also wants to give some information about differential diagnosis malignant pleural and peritoneal mesothelioma.

diagnos of mesothelioma

Mesothelioma images > Fig. 1. Axial contrast enhanced CT parenchymal (a.) and mediastinal sections (b.) shows
nodular, irregular and circumferantial right sided pleural thickening in 55 year-old man. Note that contracted right hemithorax and anterior mediastinal lymph node (arrow head). We can see pleural calcification on left sided pleural surface (arrow head).

diagnos of mesothelioma

Axial contrast enhanced CT mediastinal (a.) and parenchymal sections (b.) shows right sided irregular pleural thickening and right major fissur involvement (arrow head).

diagnos of mesothelioma

Axial non- contrast enhanced CT a milimetric parenchymal nodul in right middle lobe (arrow head)

diagnos of mesothelioma

Axial contrast enhanced CT show 1 cm paracardiac lymphadenopathy in 65 year old man with MPM.

diagnos of mesothelioma

Axial contrast enhanced CT shows pericardial invasion and pericardial effusion.

Intravenous contrast-enhanced CT is the primary imaging modality for suspected malignant mesothelioma. CT can show the whole pleural surface and diaphragm. CT findings that is seen mostly are nodular pleural thickening, unilateral pleural effusion, pleural calcification, thickening of interlobar fissur, reduction of thoracic volume (Wang et al., 2004, Ismail-Khan et al., 2006). Pleural calcification is seen approximately 20% of cases (Moore et al., 2008, Wang et al., 2004). Typically, both the visceral and parietal pleurae are involved. Malignant pleural thickening characteristically is circumferantial, nodular and > 1 cm. Also, mediastinal pleural involvement is often detected (Ismail-Khan et al., 2006). Malignant pleural mesothelioma is locally aggressive with invasion of the chest wall, mediastinum and diaphragm. Obliteration of extrapleural fat planes, invasion
of intercostal muscles, displacement of ribs, and bone destruction are findings of chest wall involvement. Heart, esophagus, trachea and major vascular structures of mediastinum may be involved by tumor. Nodular pericardial thickening and pericardial effusion refers to pericardial invasion by malignant pleural mesothelioma. Obliteration of surrounding fat planes of mediastinal organs, covering of vascular structure more than 50% is a strong evidence of invasion (Moore et al., 2008, Wang et al., 2004, Miller et al.,1996, Patz et al., 1992).
Pulmonary metastases of MPM presenting as nodules and masses and, rarely, diffuse miliary nodules may be seen at CT. Chest CT may also rarely demonstrate extrathoracic spread of MPM. Metastasis to the hilar and mediastinal lymph nodes is present at autopsy in approximately 40-45% of patients with MPM ( Miller et al., 1996, Patz et al., 1992, Dynes et al., 1992).
MRI screening is not used routinely in the assessment of malignant mesothelioma, however in patients with potentially resectable disease, MRI can help to provide additional staging information over and above CT. Using gadolinium enhancement, MRI can advance the identification of tumor extension into the diaphragm or chest wall. MRI also is preferred in some patients whom intravenous iodinated contrast is contraindicated.
Malignant pleural mesothelioma is typically isointense or slightly hyperintense on T1-weighted images and moderately hyperintense on T2-weighted images relative to adjacent chest wall muscle. After the gadolinium injection, MPM shows enhancement. MR imaging is superior to CT for showing invasion of the diaphragm and invasion of endothoracic fascia or a single chest wall focus (Moore et al., 2008, Miller et al., 1996, Patz et al., 1992).
The radiologic differential diagnosis includes metastatic pleural disease, pleural lymphoma, asbestos releated benign pleural disease, and tuberculous empyema. Pleural rind, nodular pleural thickening, pleural thickening greater than 1 cm, and mediastinal pleural involvement favor malignant pleural disease. Pleural calsification is usually seen in benign process. Mesothelioma can not be distinguished from metastatic pleural disease on CT.
Discrimination between epithelial types of mesothelioma and metastatic adenocarcinoma requires histochemical, immunohistochemical, and ultrastructural analysis. The presence of hilar-mediastinal adenopathy may be helpful in differentiating metastases and lymphoma from mesothelioma. The radiologic criteria for unresectability are tumor encasing diaphragm, invasion of extrapleural soft tissue, infiltration, displacement, or seperation of ribs by tumor, or bone destruction (Moore et al., 2008, Dynes et al., 1992, Barreiro et al., 2006, Jeong et al., 2008).

Morphologically malignant pleural mesothelioma can be seen in three forms: epithelial, sarcomatous, and mixed. The mixed form is usually mentioned as biphasic or bimorphic. Mixed tumors are composed of both epithelial and sarcomatous components. Epithelial mesotheliomas have a better diagnosis than sarcomatous and mixed tumors so differential diagnosis is very important for determining the prognosis. Epithelial malignant mesotheliomas consist of cells that are similar to normal mesothelial cells. The cells form a tubulopapillary or trabecular pattern. Epithelial malignant mesothelioma may also show prominent secretory changes, microglandular patterns, signet cell structure, or desmoplastic responses that make these tumors difficult to differentiate from adenocarcinomas based on routine histologic analysis alone. The sarcomatous pattern of malignant mesothelioma is typically consist of closely packed spindle cells. No immunohistochemical markers are spesific for malignant mesotheliomas and so there are some immunohistochemical markers such as calretinin thrombomodulin, and cytokeratin 5/6 to differentiate from metastatic adenocarcinomas and soft tissue sarcomas that have similar to histologic appearances (Levy et al., 2008).

Artikel Terkait

Radiologic Evaluation of Malignant Pleural and Peritoneal Mesothelioma
4/ 5


Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology Apk Android CT Abdomen with contrast DAMS Imaging radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun Ultrasound Hepatitis b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency