IS Case 301: Omental cake

Gunvir Gill, MD


Imaging Sciences URMC 2009
Publication Date: 2009-08-05

History

Patient is an 82-year-old female with diffuse abdominal pain and distention, subacute in onset.

Findings

Extensive omental, mesenteric, and bowel wall carcinomatous seeding.

Diagnosis

Omental cake

Discussion

The omentum, mesentery, and bowel wall are frequent sites of metastatic seeding from primary malignancies. Gynecological malignancies, particularly ovarian and endometrial, are the primary neoplasms that most often metastasize to the omentum, followed by carcinomas of the stomach, colon, pancreas, appendix, and others.

Omental caking of tumor arises from intraperitoneal seeding of tumor cells, followed by invasion of the serosal layers and subsequent growth. The symptoms are typically vague and nonspecific, which can allow the process to progress unchecked, with omental replacement by a confluent thickened soft tissue mass.

In this patient no primary tumor was identified. However, there was a remote history of hysterectomy with bilateral salpingoophorectomy, and it was possible that the tumor had been resected while still microscopic.

References

  1. Coakley FV, Choi PH, Gougoutas CA, Pothuri B, Venkatraman E, Chi D, Bergman A, Hricak H. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology. 2002 May;223(2):495-9.

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