• Most tumors affecting the peritoneum are secondary implants from intraperitoneal cancers (ovarian, gastric, pancreatic, etc)
• Primary peritoneal tumors are derived from the mesodermal lining of the peritoneum
• Patients usually present with advanced stages of disease
• History of asbestos exposure in the case of malignant mesothelioma
• The most common peritoneal neoplasms include peritoneal mesothelioma and pseudomyxoma peritonei
• Malignant mesothelioma occurs most commonly in men, with a long latent period (averaging 40 years) after prolonged asbestos exposure
• Pleural malignant mesotheliomas outnumber peritoneal by 3:1
• Pseudomyxoma peritonei is caused by a low-grade mucinous cystadenocarcinoma of the appendix or ovary that secretes large amounts of mucus-containing epithelial cells
• CT scans of the lower thorax and abdomen: Demonstrate pleural effusions, ascites, peritoneal and mesenteric thickening, and low-density soft-tissue masses involving the omentum and peritoneum
• Malignant mesothelioma may have evidence of asbestos exposure on chest film as well pleural plaques on thoracic CT
• In pseudomyxoma peritonei, US and CT scans show distinctive peritoneal scalloping of the liver margin and intra-abdominal calcified plaques
• Chronic inflammatory peritonitis
• Peritoneal mesothelioma
• Cystic mesotheliomas
• Well-differentiated papillary mesotheliomas
• Pseudomyxoma peritonei
• Benign appendiceal mucocele
• Mesenteric cyst
• Mesenteric lipodystrophy
• Abdominal lymphoma
• Thorough history (including asbestos exposure) and physical exam
• Abdominal pelvic CT scan to evaluate extent of lesion(s)
• Chest film or thoracic CT scan to evaluate for metastatic disease
• Diagnostic paracentesis: Lactic dehydrogenase (LDH) level, albumin, amylase, triglyceride level, WBC count, cytologic studies, Gram stain, and culture
• Percutaneous biopsy of accessible peritoneal thickening vs diagnostic laparoscopy with biopsy
• Symptoms seldom develop until advanced stages of disease, at which time patients have abdominal pain, distention, and frequently small bowel obstruction requiring admission
• Palliative cytoreductive surgery: Gross tumor debulking and omentectomy (plus appendectomy and bilateral salpingo-oopherectomy in pseudomyxoma peritonei)
• Intraperitoneal chemotherapy
• Adjuvant intracavitary radiation
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