Secondary Malignant Peritoneal Mesothelioma of the Greater Omentum after Therapy for Primary Pleural Mesothelioma
A 69-year-old man with histologically proven epithelioid-type primary malignant pleural mesothelioma of the right thorax was initially diagnosed by CT imaging. A localized tumor of the right pleura, without any mediastinal lymphadenopathy, pulmonary metastasis or abdominal involvement, was depicted (fig. ). Due to progression of the disease and the patient's request, palliative treatment of the coexisting large effusion included right-sided talc pleurodesis. Follow-up CT scans showed a slowly enlarging pleural tumor which was initially limited to the thoracic space. Eleven months after the diagnosis, the patient presented at our emergency department with a sudden onset of diffuse abdominal pain. An initial ultrasound examination revealed infiltration of the greater omentum, which was interpreted as omental infiltration or ‘omental cake’ (fig. ). 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. ). 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. ). One day after confirming the CT results, an ultrasound-guided biopsy of the tumorous infiltration of the greater omentum was performed. The fine needle aspiration revealed malignant mesothelial cells, which were similar to the aspirated cells in the right pleura (fig. ). Biopsy confirmed the malignant mesothelioma had the same histological architecture as seen in the patient's pleural mesothelioma (fig. ).