Diagnostic value of computed tomography and magnetic resonance imaging in ovarian malignant mesothelioma

Our plain-English summary of Diagnostic value of computed tomography and magnetic resonance imaging in ovarian malignant mesothelioma, by H.T. Wang, A.J. Li, J.Y. Gao, et al (BMC Medical Imaging, 2023).

The study

• Authors: H.T. Wang, A.J. Li, J.Y. Gao, L.J. Wang, Y.T. Wang, W.Y. Yu, J. Zhang
• Journal: BMC Medical Imaging
• Published: 2023;23(1):213
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To investigate the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in ovarian malignant mesothelioma (OMM).

Methods: The clinical and imaging data of 10 pathologically-confirmed OMM patients were analyzed retrospectively.

Result: (1) The patients were 27 years to 70 years old, with an average age of 57.2 ± 15.4 years. Seven patients reported abdominal distension and pain, 1 reported lower abdominal discomfort and decreased appetite, and 2 patients had no symptoms. (2) Two cases of localized OMM with incomplete semi-annular "capsule" observed around the localized OMM tumors were reported while 8 cases had diffuse OMM in which the tumor parenchyma showed isointense or slightly hypointense on T1WI, inhomogeneous hyperintense on T2WI, and obviously hyperintense on DWI, with obvious inhomogeneous enhancement after enhancement. Diffuse OMM was not mainly composed of ovarian masses and was mainly characterized by mild ovarian enlargement, nodular and irregular thickening of the peritoneum, cloudy omentum, unclear fat gap, and reticular or irregular thickening, which can fuse into a "cake-shape". (3) All 10 patients underwent surgery, while 9 patients underwent systemic chemotherapy or immunotherapy after surgery. All patients with localized OMM survived. Out of the 8 diffuse-type patients, 5 died, 1 was lost to follow-up, and 2 survived.

Conclusion: OMM has certain clinical and imaging characteristics. There is no liquefaction, calcification, or partition in the tumor. The ovarian enlargement in the diffuse lesion is not significant. The diffuse thickening of the peritoneum and omentum with early appearance of mural nodules and ascites in the upper abdomen, help the diagnosis of OMM.

© 2023. The Author(s).

In plain English

This was a retrospective review of 10 women with pathologically confirmed ovarian malignant mesothelioma, seen between September 2013 and July 2022 at multiple centers. The authors described how the tumors looked on CT (six patients) and MRI (four patients). Patients were aged 27 to 70. One patient had a history of asbestos exposure. The cause in the other nine was unknown, and the article did not name a fiber type. Two patients had localized tumors and eight had diffuse disease involving the peritoneum and omentum. All eight diffuse-type patients had thickening of the peritoneum and fluid in the abdomen (ascites). No lymph node metastasis was found in any of the 10. All 10 had surgery. The two localized-type patients were alive 109 and 3 months after surgery. Of the eight diffuse-type patients, five died 17 to 33 months after surgery, two were alive at 15 and 13 months, and one was lost to follow-up. The authors concluded that the tumors had certain characteristic imaging features. They noted that the number of cases was small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series (review of clinical, imaging and pathology records)
• Who was studied: 10 female patients with pathologically confirmed ovarian malignant mesothelioma, seen September 2013 to July 2022 at multiple centers, aged 27 to 70 years (average 57.2 plus or minus 15.4 years)
• Exposure: Not the focus of the study. One of the 10 patients had a history of asbestos exposure, and the cause in the remaining patients was unknown. No fiber type, job or dose was reported.
• Main results:
  • Symptoms among the 10 patients: 7 had abdominal distension and pain, 1 had lower abdominal discomfort and decreased appetite, and 2 had no symptoms
  • Average preoperative CA125 level across the 10 patients was 93.24 plus or minus 80.89 U/mL
  • Of the 10 patients, 2 had localized-type and 8 had diffuse-type tumors
  • All 8 diffuse-type patients had nodular, irregular or wavy peritoneal thickening
  • All 8 diffuse-type patients had ascites
  • No lymph node metastasis was found in any of the 10 patients
  • The epithelial (epithelioid) type made up 90% of the 10 patients (Table 2 lists 9 epithelioid and 1 mixed)
  • All 10 patients had surgery
  • The two localized-type patients survived, one for 109 months and one for 3 months after surgery
  • Of the 8 diffuse-type patients, 5 died 17 to 33 months after surgery (average 22.40 plus or minus 6.23 months)
  • Of the other diffuse-type patients, 2 were alive at 15 and 13 months after surgery, and 1 was lost to follow-up
• The authors' conclusion: The authors concluded that although ovarian malignant mesothelioma is rare, its imaging has certain characteristics: no cystic change, calcification, partition or inner-wall nodule in the tumor; diffuse lesions not mainly presenting with ovarian enlargement; and ascites that can appear early in the upper abdomen.
• Limitations the authors state:
  • Small number of cases
  • Each patient had only one type of scan (CT or MRI), so the evaluation of imaging features was one-sided
  • Cases came from multiple centers with different MRI sequences and CT phases, which may affect comparison of imaging signs
  • MRI covered only the pelvis, so lesions under the diaphragm and upper abdominal ascites could not be seen on MRI

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Parenchyma, Peritoneum, Omentum, Chemotherapy, Immunotherapy, Ascites.

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