Omental Tumor

Omental Tumor

Bruce T. Noble, MD

Table of Contents

Background
Presentation and Diagnosis
Treatment

See Also:
*See Peritoneal Carcinomatosis

Background

The Majority of Omental Tumors are Metastatic from Other Sites and Represent Advanced Disease

“Milky Spots” of the Omentum Containing Resident Macrophages May Act as Secondary Lymphoid Organs to Mitigate Inflammation and Contribute to the Spread of Malignancy

Tumors Spread by Both Direct and Hematogenous Routes

Primary Omental Tumors – Originate from the Omentum Itself (Rare)

  • Liposarcoma
  • Leiomyosarcoma
  • Hemangiopericytoma
  • Fibrosarcoma
  • Mesothelioma
  • Malignant Fibrous Histiocytoma
  • Gastrointestinal Stromal Tumor (GIST) – Can Be Primary or Secondary
  • Desmoid Tumor

Most Common Secondary Omental Tumors – Originate from Another Source and Spread to the Omentum

  • Uterine
  • Ovarian
  • Colorectal
  • Gastric

“Omental Caking” Refers to Diffuse Soft Tissue Thickening of the Omentum

  • Can Be from Metastases or Infection
  • Often Seen on CT
  • Most Common Cause: Ovarian Carcinoma

Omental Caking 1

Presentation and Diagnosis

Symptoms

  • Many Remain Asymptomatic for a Prolonged Period of Time
  • Abdominal Pain/Discomfort
  • Increased Abdominal Girth
  • Palpable Abdominal Mass
  • Nausea and Vomiting
  • Ascites
  • Weight Gain or Weight Loss

CT and MRI Can Evaluate the Tumors and Evaluate for Other Primary Intraabdominal Sources

Definitive Diagnosis is Generally Only Made by Pathologic Examination of the Tumor

Options for Tissue Diagnosis

  • Fine Needle Aspiration (FNA) – Most Often Inadequate for Tissue Sampling but Accuracy May Be Improved By Following Strict Protocols
  • Core Needle Biopsy (CNB)
  • Surgical Resection

Treatment

Management Varies by Tumor Type and Primary Source

Isolated Primary Omental Tumors are Most Often Managed by Surgical Omentectomy (Resection) with or without Chemotherapy

Peritoneal Carcinomatosis: Cytoreductive Surgery (CRS) and HIPEC if Appropriate

References

  1. Glockzin G, Schlitt HJ, Piso P. Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol. 2009 Jan 8;7:5. (License: CC BY-2.0)