Difficult to Identify: Malignant Primary Peritoneal Mesothelioma

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Difficult to Identify: Malignant Primary Peritoneal Mesothelioma Beth S. Zha, MD, PhD, Margaret Flanagan, MD, Caley Coulson, MD, Kanishka W. Garvin, MD The American Journal of Medicine Volume 128, Issue 11, Pages 1191-1194 (November 2015) DOI: 10.1016/j.amjmed.2015.06.021 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 1 Computed tomography (CT) images of the abdomen and pelvis were obtained. (A) The first abdominal CT image demonstrated an enlarged gallbladder (*) and omental infiltrates and haziness consistent with omental caking (bracket). (B) A second abdominal CT image revealed liver surface lesions (solid arrows), ascites (dashed arrow), and increased stomach distension (*). The American Journal of Medicine 2015 128, 1191-1194DOI: (10.1016/j.amjmed.2015.06.021) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 2 Gross pathology offered more information. (A) A nodular omentum and small bowel were evident. (B) More nodular deposits were evident on the peritoneum. The American Journal of Medicine 2015 128, 1191-1194DOI: (10.1016/j.amjmed.2015.06.021) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 3 Omental histology confirmed sarcomatoid, spindled, malignant peritoneal mesothelioma. (A) Calretinin (100×). (B) Vimentin (100×). (C) Pan-keratin (100×). (D) Wilms tumor-1 protein (200×). The American Journal of Medicine 2015 128, 1191-1194DOI: (10.1016/j.amjmed.2015.06.021) Copyright © 2015 Elsevier Inc. Terms and Conditions