FIGURE 4.

Malignant peritoneal mesothelioma. Contrast enhanced CT images – axial (a), coronal (b) and sagittal (c) reformatted CT images reveal gross ascites with a multilobulated heterogenously enhancing soft tissue mass lesion in the lower abdomen and pelvis. The lesion is encasing the uterus and bilateral adnexa and closely abutting the posterior and superior surface of urinary bladder. Sheet like thickening and enhancement of the parietal peritoneum, visceral peritoneum and leaves of mesentery is noted (thin white arrows) causing encasement of the bowel loops. Sheet like omental thickening (thick white arrows) and caking is seen. Mild stranding is observed in the mesenteric fat. Photomicrograph of the histopathological specimen shows cells arranged in a papillary pattern with a prominent fibrovascular core. On immunohistochemistry, these cells are positive for mesothelin (d).