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Clinical Journal of Gastroenterology

, Volume 10, Issue 4, pp 371–376 | Cite as

A case of malignant peritoneal mesothelioma suggesting the utility of combining double-contrast radiography and endoscopy with computed tomography for diagnosis

  • Hirokazu Saito
  • Shota Hasuda
  • Jiro Nasu
  • Mitsuhiko Kitaoka
  • Ikuo Matsushita
Case Report

Abstract

A 68-year-old woman presented with abdominal pain, weight loss, and vomiting. Enhanced computed tomography (CT) showed slightly increased density in the mesentery and edema of the third portion of the duodenum and proximal jejunum. Little ascites, but no primary lesion, lymph node metastases, or distant metastases, were observed. Endoscopic findings included erythema and edema in the distal duodenum and proximal jejunum without epithelial lesions. Double-contrast radiography revealed transverse ridging with convergence, suggesting a serosal lesion. We suspected disease involving the serosa, such as mesenteric panniculitis. However, the lesion was definitively diagnosed as malignant peritoneal mesothelioma based on a biopsy specimen obtained at laparotomy. The combination of transverse ridging with convergence on double-contrast radiography and mucosal edema without epithelial lesions on endoscopy was consistent with a disorder involving the serosa. Transverse ridging with convergence is helpful to diagnose serosal pathology such as malignant peritoneal mesothelioma. Combining the findings of double-contrast radiography and endoscopy with computed tomography may facilitate diagnosis of malignant peritoneal mesothelioma. Thus, in case of increased density of mesentery and wall thickness on CT image with transverse ridging with convergence on double-contrast radiography and without epithelial lesion on endoscopy, malignant peritoneal mesothelioma must be considered.

Keywords

Malignant peritoneal mesothelioma Imaging diagnosis Double-contrast radiography Endoscopic findings Enhanced computed tomography 

Notes

Acknowledgement

We would like to thank Dr. Takihiro Kamio at Saiseikai Kumamoto Hospital for valuable advice on pathological findings and Dr. Aya Kataoka, Dr. Kouichi Matsumoto, Dr. Hibiki Ohtani, and Dr. Yasushi Yoshida at Kumamoto Chuo Hospital for their assistance in examination or operation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  1. 1.Department of GastroenterologyKumamoto Chuo HospitalKumamotoJapan
  2. 2.Department of Gastroenterological SurgeryKumamoto Chuo HospitalKumamotoJapan
  3. 3.Department of Diagnostic PathologyKumamoto Chuo HospitalKumamotoJapan

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