Omentum and Mesentery

Primary GISTs rarely may arise from the omentum or mesentery54; these are usually large multilobulated masses with areas of low attenuation due to hemorrhage, necrosis, or cystic degeneration. Trace amount of free fluid in the abdomen may be present.55 CT findings of GISTs arising in these locations are not characteristic, and they are indistinguishable from other sarcomas including liposarcoma, fibrosarcoma, leiomyosarcoma, inflammatory pseudopolyp, and mesenteric fibromatosis. Therefore, presumptive diagnosis before biopsy or surgery may be difficult.

GISTs from the gastrointestinal tract may metastasize to the omentum and mesentery, resulting in multiple peritoneal masses (Figure 30.10). Patients may also develop peritonitis secondary to tumor rupture. In these cases, the differential diagnosis includes peritoneal carcinomatosis and lymphoma.

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