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Primary cystic peritoneal masses and mimickers: spectrum of diseases with pathologic correlation

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Abstract

Cystic lesions within the peritoneum have been classified classically according to their lining on histology into four categories—endothelial, epithelial, mesothelial, and others (germ cell tumors, sex cord gonadal stromal tumors, cystic mesenchymal tumors, fibrous wall tumors, and infectious cystic peritoneal lesions). In this article, we will proceed to classify cystic peritoneal lesions focusing on the degree of radiological complexity into three categories—simple cystic, mildly complex, and cystic with solid component lesions. Many intra-abdominal collections within the peritoneal cavity such as abscess, seroma, biloma, urinoma, or lymphocele may mimic primary peritoneal cystic masses and need to be differentiated. Clinical history and imaging features may help differentiate intra-abdominal collections from primary peritoneal masses. Lymphangiomas are benign multilocular cystic masses that can virtually occur in any location within the abdomen and insinuate between structures. Ultrasound may help differentiate enteric duplication cysts from other mesenteric and omental cysts in the abdomen. Double-layered wall along the mesenteric side of bowel may suggest its diagnosis in the proper clinical setting. Characteristic imaging features of hydatid cysts are internal daughter cysts, floating membranes and matrix, peripheral calcifications, and collagenous pericyst. Non-pancreatic psuedocysts usually have a fibrotic thick wall and chylous content may lead to a fat-fluid level. Pseudomyxoma peritonei appears as loculated fluid collections in the peritoneal cavity, omentum, and mesentery and may scallop visceral surfaces. Many of the primary cystic peritoneal masses have specific imaging features which can help in accurate diagnosis and management of these entities. Knowledge of the imaging spectrum of cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses.

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Acknowledgments

The authors acknowledge Dr. Chavhan for images contribution.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women’s College Hospital, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    María Arraiza, Ur Metser, Korosh Khalili, Anthony Hanbidge & Sangeet Ghai

  2. Department of Pathology, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    Rajkumar Vajpeyi

  3. Department of General Surgery, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada

    Erin Kennedy

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  1. María Arraiza
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  2. Ur Metser
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Correspondence to Sangeet Ghai.

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Arraiza, M., Metser, U., Vajpeyi, R. et al. Primary cystic peritoneal masses and mimickers: spectrum of diseases with pathologic correlation. Abdom Imaging 40, 875–906 (2015). https://doi.org/10.1007/s00261-014-0250-6

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  • DOI: https://doi.org/10.1007/s00261-014-0250-6

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