Peritoneal loose bodies and the differentiation of fatty abdominal and pelvic lesions

Abstract

Peritoneal loose bodies (PLBs) have been sparingly documented within the surgical and radiologic literature, with 38 cases reported to date. A 67-year-old male presented to urology for the management of an asymmetric prostatic nodule. Imaging incidentally identified a well-circumscribed mass of low T2 signal intensity with a small fatty core in the left lower quadrant close to the sigmoid colon; malignancy was in the differential. The mass grew slightly over the next year. A diagnostic laparoscopy retrieved a free floating 4 × 4 cm benign mass from the pelvis, identified as necrotic fat with areas of dystrophic calcifications. PLBs are often a diagnostic dilemma without surgical intervention. Here we present a diagnostic algorithm based on a comprehensive literature review and our case to help better identify unknown abdominal and pelvic fatty masses and to avoid surgery strictly for diagnosis, especially for patients that are not ideal surgical candidates. Using this algorithm, the mass in the patient presented here could have been accurately characterized without invasive diagnostic measures.

Exploratory laparoscopy as first choice procedure for the diagnosis of giant peritoneal loose body: a case report

“…Only 38 cases of PLB have been reported in the literature to date. 1 Preoperative diagnosis is often difficult, and PLBs are usually found by chance during physical examination, surgical exploration, or autopsy. Most patients with PLBs have no clinical symptoms, despite the presence of large free bodies in the abdominal cavity, often reaching a diameter >5 cm.…”

“… 5 MRI, in combination with a new algorithm, may thus be used to increase the diagnostic accuracy of PLB lesions. 1 …”

“…5 MRI, in combination with a new algorithm, may thus be used to increase the diagnostic accuracy of PLB lesions. 1 Understanding the specific features of GPLB before surgery can help to prevent its misdiagnosis and avoid unnecessary surgical exploration. Notably, small asymptomatic PLBs often require no special treatment and can be monitored by regular medical reviews; however, active surgical exploration (i.e., laparoscopy or open surgery) remains the best option for patients with GPLB.…”

“…Because the disease is rare in clinical practice, most physicians and radiologists lack knowledge of PLBs, and GPLBs are often misdiagnosed as stromal tumors or teratomas, with a rate of misdiagnosis following CT as high as 63%. 1 PLBs typically appear as a central calcified nodule on CT, with soft-tissue density at the periphery and a clear, smooth boundary. [6][7][8] The current patients underwent CT, but not magnetic resonance imaging (MRI) examination.…”