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ABDOMINAL IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 1  |  Page : 41-42
Case Report : Malignant mesothelioma of the peritoneum presenting as inguinoscrotal mass


MGM Hospital/Kakatiya Medical College, Warangal-506007, India

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Keywords: Inguinoscrotal lump, mesothelioma

How to cite this article:
Moorthy N, Dattatreya D S, Madhavilatha R, Madhubabu P. Case Report : Malignant mesothelioma of the peritoneum presenting as inguinoscrotal mass. Indian J Radiol Imaging 2004;14:41-2

How to cite this URL:
Moorthy N, Dattatreya D S, Madhavilatha R, Madhubabu P. Case Report : Malignant mesothelioma of the peritoneum presenting as inguinoscrotal mass. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Sep 20];14:41-2. Available from: http://www.ijri.org/text.asp?2004/14/1/41/28552
Mesothelioma is a rare malignant tumour arising from the serosal layers of the pleura, peritoneum and pericardium. Peritoneal involvement is seen mostly in men above 40 years and is associated with heavy asbestos exposure. They usually present as ascites or intermittent partial bowel obstruction. Rarely they may manifest in a hernial sac or in the umbilicus. In some cases inguinal or cervical lymphadenopathy from the metastasis is the first sign of the tumour.

A 21 years old male presented with a painless firm irreducible right inguinoscrotal swelling of four months duration. The testis is palpated separately from the mass. There is no history of recurrent symptoms of intestinal obstruction. There is no ascites. Routine lab tests and chest radiograph were normal. US showed a large lobulated mixed echogenic mass in the right inguinal region extending into scrortum. The testes and epidydimis were normal. There is no hydrocele. Rest of the abdomen was normal CT Scan revealed a large heterogeneous mixed density right inguinoscrotal mass. Testis was seen separately. Total excision of the tumour with orchidectomy was performed. Histopathology showed a highly cellular tissue. Solid islands septated by dense fibro collagenous tissue cells cuboidal, arranged in tubular formation and traberculae seen. Feto areas of slit like spaces surrounded by neoplastic cells are seen, suggestive of monomorphic epithelial type of mesothelioma. Testis and cord were normal.

CT findings of the malignant mesothelioma include nodular or irregular thickening of peritoneum, thickening of omentum and mesentry and ascites [1]. It can also present as multiloculated cystic mass [2]. The mesentry gives a "stellate" appearance due to thickening of perivascular bundles. Gross appearance of the condition include multiple plaques or nodules scattered over visceral and parietal peritoneum accompanied by dense intraperitoneal adhesions and shortening of mesentry. Mesotheliomas are classified histologically into epithelial (Most common), sarcomatoid and mixed tuberculous peritonitis, non Hodgkins's lymphoma, peritoneal carcinomatosis and pseudomyxoma peritonei [3]. The amount of liquor in relation to the soft tissue component differentiates this condition from the above diseases [4]. Cystic mesothelioma is a rare benign neoplasm mostly seen in women and is not associated with exposure to asbestos. The cyst varies in size and mimics lymphangoima and ovarian cyst mostly [5].

The treatment options include radical surgery in combination with chemotherapy and radiotherapy and adjuvant modalities like immuno and gene therapy [6].



 
   References Top

1.Guest PJ, Reznek RH, Selleslage et al . Peritoneal mesothelioma: The role computed tomography in diagnosis and follow up clin Radiol 1992; 45: 79-84.   Back to cited text no. 1    
2.O NEIL JD, ROS PR, STORM BL et al . Cystic mesothelioma of the peritoneum Radiology 1989; 170: 333-337.   Back to cited text no. 2    
3.JAY HEIKEN and STEVEN S. WINN in: abdominal and peritoneal cavity chapter 16. Joseph K. T. LEE and STUART S. SAGEL et al in Computed tomography with MRI correlation, third edition Vol 2 Lippencott - Raven publishers Philadelphia 1998 p 1000 - 1004.   Back to cited text no. 3    
4.BEUTER K. BAPTOPOULOUS V, REAL E, et. Al. Diagnosis of peritoneal mesothelioma: computed tomography, sonography and fine - needle aspiration biopsy. AJB 1983; 140: 1189.   Back to cited text no. 4    
5.JUAN ROSAL M.D. peritoneum, retroperitoneum and related structures chapter 26 in Ackerman's Surgical Pathology. 8th edition Vol 2 Har court Brace and Company Asia Ltd 1997 p 2138-2145.   Back to cited text no. 5    
6.SINGHAL S, KAISER LB. MALIGNANT MESOTHELIOMA: options for management, surg Clin North Am Aug: 82 (4): p 797-831.   Back to cited text no. 6    

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Correspondence Address:
NLN Moorthy
3-6-779/6 st no 14, Himayat Nagar, Hyderabad-500 029
India
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