Malignant mesothelioma of the greater omentum mimicking omental infarction: A case report

Abstract

Mesothelioma develops most commonly in the pleura, and less frequently in the peritoneum. Usually, it manifests as diffuse peritoneal thickening and multiple nodules, and rarely as a solitary mass. We report a rare case of primary malignant mesothelioma of the greater omentum, which mimicked omental infarct. A 54-year-old Korean man was admitted because of severe abdominal pain of sudden onset. A tender mass with indistinct margins was palpated in the upper abdomen. Abdominal ultrasound and computed tomography showed an illdefined mass in the greater omentum and little ascites in the peri-hepatic space, and neutrophil-dominant exudates were documented on paracentesis. Intravenous antibiotics and analgesics were given for omental infarction with superimposed infection, which resulted in symptomatic improvement. The imaging studies after a week revealed a growing mass and ascites. Laparoscopic surgery was performed and an 8 cm × 3.3 cm greater omental mass was found, with multiple small nodules on the peritoneum, diaphragm, and pelvic cavity wall. Histological examination showed proliferating malignant epithelioid cells that stained strongly for calretinin, which was compatible with malignant mesothelioma. We recommend that primary omental mesothelioma should be included in the differential diagnosis of patients with omental infarction, despite its rarity.

Secondary Malignant Peritoneal Mesothelioma of the Greater Omentum after Therapy for Primary Pleural Mesothelioma

“…After being expectorated, the fibers penetrate the bowel wall and end up in the lymphatic and splanchnic circulation [10]. Imaging features associated with primary malignant mesothelioma include nonspecific findings of ascites, omental thickening and smooth contrast enhancement of the peritoneum [8], which lead to a wide range of differential diagnoses such as metastatic peritoneal carcinomatosis, peritonitis or omental infarction [3, 8]. …”

“…A rare manifestation of mesothelioma is a primary tumor originating from the peritoneum [1]. Only a few cases of peritoneal mesothelioma have been reported in the literature [2, 3, 4], and all publications described primary peritoneal mesothelioma without the coexistence of other tumors, especially pleural mesothelioma [4]. …”

Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure

“…Patients presenting with the diffuse symptoms of abdominal pain, distention, nausea or an abdominal mass potentially pose a challenge because these symptoms could suggest a multitude of differential diagnoses 10. Abdominal pain, distention and nausea could be symptoms of gastrointestinal diseases, and abdominal masses may be observed in cases of fibrosis, adenocarcinoma or lymphoma 5 11 12…”

“…Primary peritoneal mesothelioma is a rare disease with a crude incidence rate of 0.12 per 100 000 person years 4. Peritoneal mesothelioma may pose a diagnostic challenge since there is no definitive way to recognise this malignancy based solely on radiologic or clinical appearances 5. The non-specific symptoms that the patients with mesothelioma present with are abdominal distention, pain, nausea and ascites.…”

Idiopathic Omental Ischemia Treated by Laparoscopy : Case Report

“…Leitner et al classified omental infarction into primary and secondary types. Torsion of the omentum (secondary to anatomic malformations, hernia, tumor, or adhesion), thrombosis due to various causes and congestion of the mesenteric veins (systemic diseases such as vasculities, hypercoagulable states, and pancreatitis) [1,3,[10][11][12] were considered to be secondary, whereas cases with no identified causes are called idiopathic infarction of the greater omentum [2,[6][7][8]13]. Obesity was considered, by some authors, to be a risk factor.…”