PMC3656693_01
Initial axial CT at the mid-abdominal level reveals no infiltration of the greater omentum and absence of ascites.
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F1
A localized tumor of the right pleura, without any mediastinal lymphadenopathy, pulmonary metastasis or abdominal involvement, was depicted (fig. 1).
Abdominal ultrasound, performed 11 months after the diagnosis of pleural mesothelioma, shows a diffuse and large infiltration of the greater omentum (curved arrow) with close proximity to the peritoneum (straight arrow). Color Doppler ultrasound depicts a moderate vascularity of the tumor mass.
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F2
An initial ultrasound examination revealed infiltration of the greater omentum, which was interpreted as omental infiltration or 'omental cake' (fig. 2).
Follow-up axial CT of the abdomen confirms the tumorous infiltration of the greater omentum (known as omental cake, arrow) and ascites (arrowhead), as could be seen on the preceding ultrasound.
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F3
CT scans of the thorax and abdomen confirmed the diffuse tumor infiltration of the greater omentum as well as the free fluid in all 4 abdominal quadrants (fig. 3).
Sagittal reformation of the middle abdomen demonstrates the diffuse infiltration extending from the right pleural space (arrow) and abdominal cavity. Infiltration of the greater omentum can be seen with typical confirmation of the omental cake (curved arrow). Additionally, free infradiaphragmatic fluid is depicted (arrowhead).
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F4
Interestingly, the origin of the abdominal tumor was progressive infiltration of the right pleural mesothelioma through the right diaphragm into the abdomen and the greater omentum (fig. 4).
Aspiration of ascites shows atypical mesothelial cells, originating from the primary tumor in the right pleura, consistent with malignant secondary peritoneal mesothelioma.
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F5
The fine needle aspiration revealed malignant mesothelial cells, which were similar to the aspirated cells in the right pleura (fig. 5).
Histological analysis (HE staining) shows infiltrating malignant mesothelioma (arrows) within the greater omentum. In combination with the cytological results, secondary peritoneal mesothelioma, originating from the previously diagnosed pleural mesothelioma with infiltration of the abdominal space, was confirmed.
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F6
Biopsy confirmed the malignant mesothelioma had the same histological architecture as seen in the patient's pleural mesothelioma (fig. 6).