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Neoplastic diseases of the peritoneum and mesentery.

Pathophysiology The peritoneum is a serous membrane of mesothelial cells that lines the inner surface of the abdominal cavity and envelops many of the major solid and hollow organs. The peritoneum has a surface area, at 1.8 m2, that is equivalent to the skin’s, and it serves to provide a frictionless, lubricated surface over which the viscera can move [1, 2]. Primary neoplasms of the peritoneum are rare and have diverse clinical and imaging characteristics ranging from the uniformly lethal diffuse malignant mesothelioma to lower-grade lesions such as welldifferentiated papillary mesothelioma and multicystic mesothelioma. Neoplastic peritoneal diseases can be focal or diffuse and are often referred to as “wet” or “dry” on the basis of the presence or absence of ascites, respectively. Patterns of peritoneal disease include peritoneal thickening in a plaque, nodular, or sheetlike fashion. Infiltration of the subperitoneal fat results in stranding and nodularity that may progress to pleating (linearly orientated tumor infiltrate) and overt soft-tissue replacement known as “omental cake” [1, 2]. Involvement of the serosal surfaces of the small intestine may result in a focal or segmental change in caliber or abnormal kinking of the bowel, sometimes resulting in intestinal obstruction.