Spread of Metastatic Disease in the Abdomen

J.A. Brink1,T. Hany2

1 Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA

2 Nuclear Medicine,Zurich University Hospital,Zurich, Switzerland

Neoplastic disease may spread within the abdomen by embolic metastasis, lymphatic extension, direct invasion, and intraperitoneal seeding. Direct invasion may occur from contiguous primary tumors and usually implies that a locally aggressive tumor has broken through fascial planes. Direct invasion from non-contiguous primary tumors typically occurs via spread along the peritoneal ligaments and mesenteries. Intraperitoneal spread of malignancy occurs initially through seeding of the peritoneal cavity with metastatic cells. Tumor spread occurs via the natural flow of ascitic fluid within the peritoneal spaces, which, in turn, are defined by the peritoneal ligaments and mesenteries.

Tumors that arise within the abdominal cavity have the propensity to spread via the peritoneal ligaments and mesenteries that suspend their organs of origin, either by lymphatic extension or direct invasion, or via seeding of the peritoneal spaces in which they reside. Although the anatomy of the peritoneal ligaments, mesenteries, and spaces is complex, a working knowledge of this anatomy permits one to narrow the diagnostic possibilities when metastatic disease is recognized [1].

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