Amyloidosis of the mesentery and small intestine presenting as a mesenteric haematoma

Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities

Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.

Magnetic Resonance Imaging, the Virtual Biopsy of Mesenteric Masses

ABSTRACT

The mesentery may be affected by multiple disease processes. Magnetic resonance imaging aids as a virtual pathological biopsy tool in the assessment of mesenteric masses because of superior soft tissue contrast and characterization. In this comprehensive review, we describe in detail the magnetic resonance imaging features of some solid and cystic mesenteric masses, with an emphasis on lesion-specific signal characteristics on T1- and T2-weighted images, diffusion-weighted imaging, and enhancement features on the dynamic postcontrast phase that aid in narrowing the differential diagnosis.

Peritoneal amyloidosis: unusual localization of gastrointestinal amyloidosis

Amyloidosis is a rare disease that results from the extracellular deposition of amorphous fibrillar protein. It is usually observed in a systemic form. Gastrointestinal involvement is frequent but peritoneal localization is unusual. A 43-year-old male was investigated for nephritic colic. Morphologic explorations revealed small intestine agglomerans in the periumbilical region, infiltration of peritoneal fat and multiple coelio-mesenteric lymph nodes. There were no clinical or biological abnormalities and endoscopic examinations were normal. The patient then underwent an exploratory laparoscopy. Macroscopically false membranes were seen throughout the peritoneum and small bowel without ascites. Anatomopathologic examination diagnosed peritoneal amyloidosis. After several investigations a diagnosis of a primary peritoneal amyloidosis was confirmed. The patient was treated with melphalan and prednisone with a favorable outcome. Our case illustrates a particular presentation of peritoneal amyloidosis. Despite improved imaging methods, peritoneal biopsy remains essential for diagnosis.

Primary hepatic amyloidosis: report of an unusual case presenting as a mass

Hepatic involvement of amyloidosis is common. Diffuse infiltration with hepatomegaly is a usual radiologic finding of hepatic amyloidosis. To our knowledge, this is the first case of amyloidosis involving the liver that presented as a mass.

Mesenteric amyloid deposition as the initial presentation of multiple myeloma

Despite many recent progresses in diagnostic modalities, occasionally the initial manifestation of the diseases may be misleading. Therefore, to consider the uncommon presentations of prevalent diseases may be of help. Plasma-cell dyscrasia is one of the most well-known haematological malignancies. Clonal expansion of plasma cells results in diverse clinical findings, such as renal failure, lytic bone lesion, anaemia, hyperviscosity syndrome and so forth. However, this disease entity rarely presents with abdominal mass due to mesenteric amyloid deposition. Here we report a case of a 53-year-old Iranian woman who presented with a 4-month history of abdominal pain and fullness; she was finally found to suffer from small bowel mesenteric amyloidosis in the context of multiple myeloma.

Imaging features of small intestinal amyloidosis: a case report

Amyloidosis is a rare disease characterized by forming pathological protein deposits in organs or tissues. The localized form of amyloidosis affecting small intestine is rare. We report a case of small intestine amyloidosis which presented gastrointestinal bleeding and abdominal pain. We also display radiologic features of amyloidosis of the small bowel which will add evidence to accurate diagnosis and management.

[Peritoneal AA amyloidosis simulating peritoneal carcinomatosis: a case report]

Amyloidosis is a group of deposition diseases that are classified according to the type of fibers accumulated and their characteristics. It can affect any organ. The clinical presentation depends on the organs and systems involved. We present the case of a patient with a history of Hashimoto's thyroiditis and systemic symptoms who presented with abdominal pain. Physical examination detected a palpable mass in the umbilical region. CT showed thickening of the wall of the colon with infiltration of the adjacent peritoneum and extension to the root of the mesentery with abundant ascites. The histological diagnosis was peritoneal AA amyloidosis.

Jejunal Amyloidoma - a rare cause of gastrointestinal bleeding

We report a case of localized amyloid tumor of the jejunum which presented with abdominal pain and gastrointestinal bleeding. We reviewed the pathophysiologic process that precipitates bleeding in this rare tumor. We also examined the documented radiologic and endoscopic features of amyloidosis of the small bowel in the light of our reported case. All with a view to add to the growing evidence on this rare tumor which will facilitate accurate diagnosis and management.