Images in Surgery| Volume 144, ISSUE 3, P473-475, September 2008

Mesenteric and omental amyloidosis mimicking intraperitoneal carcinomatosis

Published:February 28, 2008DOI:
      A 70-year-old female patient with a previous history of hysterectomy and adnexectomy presented with a large pelvic mass. CA-125 was obtained and was found to be elevated (240 U/mL). CEA and CA19-9 were within normal limits (11 U/mL and 2.1 ng/mL, respectively). Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast revealed a diffuse, nodular, ill-defined infiltrating mass with innumerable calcifications in the greater omentum filling the peritoneal cavity suggesting peritoneal carcinomatosis (Fig 1). There was infiltrative involvement of the mesentery of the small bowel and transverse and sigmoid colon's with perivascular encasement and thickening of the wall of the sigmoid colon (Fig 2). Ultrasound needle-guided biopsy revealed fat necrosis without evidence of malignancy. Flexible sigmoidoscopy was performed and revealed narrowing of the sigmoid colon 35 cm from the anal verge.
      Figure thumbnail gr1
      Fig 1Axial CT of the abdomen with oral and intravenous contrast at the level of the kidneys showing infiltrating mass in the left side of the greater omentum with scattered calcifications (white arrow) and infiltrating mass in right side of the transverse mesocolon with perivascular encasement (black arrow).
      Figure thumbnail gr2
      Fig 2Axial CT of the pelvis showing an infiltrating mass in right side of small bowel mesentery with perivascular encasement (white arrow) and infiltrating mass in sigmoid mesentery with scattered calcifications (black arrow).
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