The clinical and radiologic presentation of mesotheliomas is nonspecific. History can be very elusive because the most frequent symptom at presentation is abdominal pain. Routine laboratory tests are not useful in making the diagnosis, and abdominal radiographs will show signs such as abdominal distension.
Potentially useful serum markers for diagnosis and follow-up are the serum mesothelin-related protein (SMRP), which is elevated in more than 84% of mesotheliomas, and has a 60% sensitivity at diagnosis; CA-125, CA 15-3, hyaluronic acid, and osteopontin[24–26] are other potential markers.
Computed tomography (CT) findings of peritoneal mesothelioma are nonspecific and not sufficient to establish a diagnosis; however, CT is useful for the detection, characterization, staging, and guiding biopsy of peritoneal masses.[27]
At CT, MPM appears as solid, heterogeneous, enhancing soft-tissue masses. Its growth pattern is expansive more than infiltrating.[13] There are 3 types of CT appearances described.
'Dry-painful' type is the most common, in which CT shows 1 large mass or multiple small peritoneal masses in 1 abdominal quadrant, with no signs of ascites. The 'wet' type is associated with intestinal distension and ascites, widespread small nodules and plaques, and no solid masses. Finally, there is the 'mixed' type.[28]
Few data have been published about the sonographic and magnetic resonance imaging manifestations of peritoneal mesothelioma.
A precise diagnosis based on imaging findings alone is not possible. Furthermore, distinguishing a benign from a malignant process as well as a primary from a metastatic process is also challenging. Therefore, the definitive diagnosis of peritoneal mesothelioma depends on histologic and immunohistochemical examination.
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