101
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Makis W. Progressing Sclerosing Mesenteritis (Mesenteric Panniculitis) Mimics Progression of Malignancy After Neoadjuvant Chemotherapy for Gastric Adenocarcinoma on Serial 18F-FDG PET/CT. Clin Nucl Med 2016; 41:313-6. [PMID: 26359565 DOI: 10.1097/rlu.0000000000000965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 62-year-old man was diagnosed with a moderately differentiated gastric adenocarcinoma in the proximal stomach. A staging 18F-FDG PET/CT showed an intensely FDG-avid gastric mass, as well as a mildly FDG-avid misty nodular mesentery. After 3 cycles of neoadjuvant chemotherapy, a follow-up PET/CT showed partial response of the gastric primary, with increase in the size of nodules in the mesentery and increased FDG uptake, raising concern of secondary malignancy. Biopsy of the mesentery revealed xanthogranulomatous inflammation, consistent with sclerosing mesenteritis.
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Affiliation(s)
- William Makis
- From the Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, Alberta, Canada
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102
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Apostolakis S, Ioannidis A, Tsioga G, Papageorgiou K, Velimezis G. A systematic investigation of sclerosing mesenteritis through CT and MRI. Radiol Case Rep 2016; 11:299-302. [PMID: 27920848 PMCID: PMC5128563 DOI: 10.1016/j.radcr.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022] Open
Abstract
Sclerosing mesenteritis is primarily diagnosed through histologic and radiologic evaluation; however, only a few works provide a systematic description using MRI. This work presents the case of a 68-year-old male, who was admitted for a routine cholecystectomy. Intraoperativly, a large mass was identified dislocating the abdominal viscera. The microscopic examination revealed vascular congestion of the omentum. The contrast-enhanced CT and MRI scans revealed the presence of a heterogenous, lipomatous mass with lesions visible only in T2W and contrast-enhanced T1W MRI. Based on these findings, the diagnosis of sclerosing mesenteritis was made. According to the available literature, depending on the stage of sclerosing mesenteritis, different radiologic features are encountered; however, it is possible that features from more than one form of the condition coexist in the same lesion. We therefore suggest that a combination of MRI sequences should be acquired for a more accurate staging of the condition.
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Affiliation(s)
- Sotirios Apostolakis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
| | - Argyrios Ioannidis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
| | - Garyfalia Tsioga
- Magnetic Resonance Imaging Department, Sismanoglion Hospital, Amarousion, Greece
| | | | - Georgios Velimezis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
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103
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Abe A, Manabe T, Takizawa N, Ueki T, Yamada D, Nagayoshi K, Sadakari Y, Fujita H, Nagai S, Yamamoto H, Oda Y, Nakamura M. IgG4-related sclerosing mesenteritis causing bowel obstruction: a case report. Surg Case Rep 2016; 2:120. [PMID: 27797069 PMCID: PMC5086477 DOI: 10.1186/s40792-016-0248-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/25/2016] [Indexed: 01/27/2023] Open
Abstract
Sclerosing mesenteritis (SM) is a rare inflammatory and fibrosing disease primarily involving the small-bowel mesentery. Recently, SM was reported to be closely related to IgG4-related disease (IgG4-RD). This report describes a patient with SM associated with IgG4-RD. A 77-year-old woman with a history of surgery for ectopic pregnancy and wound dehiscence presented with intestinal obstruction. Abdominal enhanced computed tomography (CT) revealed an enhanced, radially shaped, oval mass, 3 cm in diameter, with an unclear rim in the mesentery of the distal ileum, which may have involved the distal ileum. To remove the cause of bowel obstruction, the SM was resected completely and the ileum was resected partially. Histologic examination showed that the mass was composed of spindle cells arranged in a fascicular or storiform pattern; moreover, fibrous stroma was observed, with dense lymphoplasmacytic infiltration and lymphoid follicles. Immunohistochemically, numerous IgG4-positive plasma cells were observed, at a density of 253 per high-powered field, and the IgG4/IgG ratio was about 50 %. Elastica van Gieson (EVG) staining also showed obstructive phlebitis. These findings indicated IgG4-related SM. Although the accurate diagnosis of SM remains difficult without histological analysis, IgG4-RD should be included in the differential diagnosis of unknown mesenteric tumors. Identification of IgG4-RD may prevent unnecessary surgery because corticosteroids may be effective in these patients.
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Affiliation(s)
- Atsushi Abe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Tatsuya Manabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuyoshi Takizawa
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Takashi Ueki
- Department of Surgery, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Daisuke Yamada
- Department of Surgery, Japan Community Health Care Organization, Kyushu Hospital, Fukuoka, 806-8501, Japan
| | - Kinuko Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Sadakari
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hayato Fujita
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shuntaro Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
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104
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Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1:238-247. [PMID: 28404096 DOI: 10.1016/s2468-1253(16)30026-7] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022]
Abstract
Systematic study of the mesentery is now possible because of clarification of its structure. Although this area of science is in an early phase, important advances have already been made and opportunities uncovered. For example, distinctive anatomical and functional features have been revealed that justify designation of the mesentery as an organ. Accordingly, the mesentery should be subjected to the same investigatory focus that is applied to other organs and systems. In this Review, we summarise the findings of scientific investigations of the mesentery so far and explore its role in human disease. We aim to provide a platform from which to direct future scientific investigation of the human mesentery in health and disease.
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Affiliation(s)
- J Calvin Coffey
- Graduate Entry Medical School, 4i Centre for Interventions in Infection, Inflammation and Immunity, University Hospital Limerick, University of Limerick, Limerick, Ireland.
| | - D Peter O'Leary
- Graduate Entry Medical School, 4i Centre for Interventions in Infection, Inflammation and Immunity, University Hospital Limerick, University of Limerick, Limerick, Ireland
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105
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Gray EJ, Darvishzadeh A, Sharma A, Ganeshan D, Faria SC, Lall C. Cancer therapy-related complications in the bowel and mesentery: an imaging perspective. Abdom Radiol (NY) 2016; 41:2031-2047. [PMID: 27277528 DOI: 10.1007/s00261-016-0799-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cancer therapy-induced complications in the bowel and mesentery are fairly common. It is important for clinicians to be aware of these complications and the agents most frequently implicated. Cancer therapy is rapidly evolving and often encompasses both classic cytotoxic drugs and newer molecular targeted agents. Drugs from both broad classes can have numerous adverse effects on the bowel and mesentery that can be detected on imaging. These adverse effects include ileus, various forms of enterocolitis, gastrointestinal perforation, pneumatosis intestinalis, secretory diarrhea, and sclerosing mesenteritis. These complications are diverse and range from relatively benign to life threatening. The management is also variable, but many of these conditions are easily controlled and reversed with supportive care and cessation of the particular cancer therapy. The objective of this pictorial essay is to demonstrate some of the more common cancer therapy-induced complications of the bowel and mesentery, with a focus on the radiographic findings.
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Affiliation(s)
- Eric J Gray
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA.
| | - Ayeh Darvishzadeh
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Ankush Sharma
- Department of Internal Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Silvana C Faria
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA
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106
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Buchwald P, Diesing L, Dixon L, Wakeman C, Eglinton T, Dobbs B, Frizelle F. Cohort study of mesenteric panniculitis and its relationship to malignancy. Br J Surg 2016; 103:1727-1730. [DOI: 10.1002/bjs.10229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/13/2016] [Accepted: 05/13/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Mesenteric panniculitis (MP) is a rare condition that historically has been associated with the presence of malignancy. Paraneoplastic phenomena in general regress with cure and in most cases with treatment of the cancer. This study was undertaken to determine whether MP regressed with cancer treatment and cure.
Methods
This was a retrospective review of a database of all patients with MP confirmed on CT between 2003 and August 2015 at Christchurch Hospital. Patients were categorized as having malignant or non-malignant disease, and follow-up scans were assessed for remission of MP. Patients with malignancy were further categorized as having malignancy cured or not cured.
Results
A total of 308 patients were identified with possible MP; 135 were excluded as radiological appearances were not typical of MP (43 patients) or there was no follow-up CT (92). Of 173 patients (131 men) included, 75 (43·4 per cent) were diagnosed with malignancy. Follow-up imaging showed that 33 patients (19·1 per cent) had remission of MP, whereas 140 (80·9 per cent) had no remission. There was no difference in the rates of MP remission in the malignancy versus no malignancy groups (P = 1·000), or between groups in which malignancy was cured or not cured (P = 0·572). Nor was there any difference in the rates of MP remission in malignancy cured versus no malignancy groups (P = 0·524).
Conclusion
MP does not behave like a paraneoplastic phenomenon. The association with malignancy is most likely an epiphenomenon of the many CT images acquired for staging of cancer.
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Affiliation(s)
- P Buchwald
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Diesing
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Dixon
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - C Wakeman
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - T Eglinton
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - B Dobbs
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - F Frizelle
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
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107
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Undiagnosed Sjögren's Syndrome Presenting as Mesenteric Panniculitis. Case Rep Rheumatol 2016; 2016:7207638. [PMID: 27366340 PMCID: PMC4912998 DOI: 10.1155/2016/7207638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Mesenteric panniculitis is a rare inflammatory and fibrotic process that affects the small intestine mesentery. It may occur following abdominal surgery or in association with a variety of conditions, including malignancy, infection, and certain autoimmune and inflammatory conditions. Herein, an unusual case of mesenteric panniculitis in a patient with primary Sjögren's syndrome will be presented. The patient presented with abdominal pain, weight loss, sicca symptoms, fatigue, and arthralgia. An abdominal CT revealed mesenteric fat stranding and prominent lymph nodes of the small intestine mesentery. She was found on laboratory workup to have positive antinuclear and anti-SSa antibodies. Minor salivary gland lip biopsy revealed focal lymphocytic sialadenitis. The patient's symptoms and CT findings improved with corticosteroids. This case suggests that Sjögren's syndrome should be considered as an underlying disease process in the evaluation of patients with mesenteric panniculitis.
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108
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Ayala Gutiérrez MDM, de Ramón Garrido E. [Mesenteric panniculitis]. Med Clin (Barc) 2016; 146:497-505. [PMID: 26971978 DOI: 10.1016/j.medcli.2016.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
Mesenteric panniculitis is a condition characterized by chronic nonspecific inflammation of the mesentery. There is little and often confusing information about its characteristics and the approach to take once it has been demonstrated by an imaging test. We propose to describe the epidemiological, clinical, laboratory, radiological and pathological features of the patients with mesenteric panniculitis reported in the literature, as well as possible disorders causal or associated with mesenteric panniculitis, in the opinion of the authors of each study. Finally, we will review the different therapeutic options used and the response to them. To that end a literature search was performed from the main medical databases selecting ítems with information on these aspects. This information was collected on a database stored in SPSS software for further analysis and summary.
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109
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Bae SH, Park SJ, Kim WS, Lee MW, Kim JS. Mesenteric Panniculitis in a Thirteen-Year-Old Korean Boy Treated with Prednisolone: A Case Report. Pediatr Gastroenterol Hepatol Nutr 2016; 19:143-6. [PMID: 27437192 PMCID: PMC4942313 DOI: 10.5223/pghn.2016.19.2.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/05/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022] Open
Abstract
Pediatric mesenteric panniculitis is an extremely rare disease of unknown etiology characterized by chronic inflammation, fat necrosis, and fibrosis in the mesenteric adipose tissue. A previously healthy 13-year-old boy was admitted because of right upper abdominal pain. An abdominal computed tomography scan revealed increased attenuation and enhancement in the left upper abdominal omental fat and anterior peritoneal wall thickening. A laparoscopic biopsy showed mesenteric panniculitis with chronic inflammation, adiponecrosis, and septal fibrosis. Serological tests for autoimmune diseases, nested polymerase chain reaction for Mycobacterium tuberculosis, and special immunohistochemical stains for malignancy were all negative. Symptomatic improvement and improved abnormal findings were achieved after an 8-month treatment with prednisolone according to a follow-up abdominal computed tomography scan. Here, we report a case of pediatric mesenteric panniculitis treated with prednisolone.
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Affiliation(s)
- Sun Hwan Bae
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Se Jin Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Soo Kim
- Department of General Surgery, Konkuk University School of Medicine, Seoul, Korea
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110
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Serosal involvement in IgG4-related disease: report of two cases and review of the literature. Rheumatol Int 2016; 36:1033-41. [PMID: 27207156 DOI: 10.1007/s00296-016-3501-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/16/2016] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a recently described entity characterized by lymphoplasmacytic infiltrates, usually mimicking tumors, affecting almost every organ or system. Nevertheless, serosal involvement has been rarely reported. In this article, we report two cases of IgG4-RD with serosal involvement and review the literature. Because of the varied clinical pictures found in our review, we suggest a new terminology for the description of IgG4-RD with serosal involvement.
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111
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Harvin G, Graham A. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction. Case Rep Gastroenterol 2016; 10:63-7. [PMID: 27403104 PMCID: PMC4929367 DOI: 10.1159/000444413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/12/2015] [Indexed: 12/21/2022] Open
Abstract
Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction.
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Affiliation(s)
- Glenn Harvin
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, N.C., USA
| | - Adam Graham
- Division of Gastroenterology, Hepatology and Nutrition, Brody School of Medicine, East Carolina University, Greenville, N.C., USA
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112
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Shah S, Mahy G, Roche E. Rare case of sclerosing mesenteritis and low grade follicular lymphoma. World J Clin Cases 2016; 4:108-111. [PMID: 27099861 PMCID: PMC4832116 DOI: 10.12998/wjcc.v4.i4.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/06/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
An unusual case of long standing sclerosing mesenteritis; initially presented with recurrent abdominal pain and a mesenteric mass with surrounding fat oedema and stranding with a pseudocapsule and fat ring sign were clearly visualised on the initial computed tomography scan. Laparotomy showed diffuse thickening at the root of the mesentery and histology from this specimen revealed fat necrosis and reactive lymphoid tissue consistent with sclerosing mesenteritis. Initial treatment with steroids and tamoxifen relieved the symptoms and the mass. He was maintained on tamoxifen. Three years later he developed a recurrence of his symptoms and abdominal mass that responded to a course of steroids. Two years following this, he developed a follicular Hodgkin’s lymphoma.
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113
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Unlu E, Okur N, Acay MB, Kacar E, Ozdinc S, Balcik C, Tokgoz OT. The Prevalence of Incidentally Detected Idiopathic Misty Mesentery on Multidetector Computed Tomography: Can Obesity Be the Triggering Cause? Can Assoc Radiol J 2016; 67:212-7. [PMID: 27050489 DOI: 10.1016/j.carj.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/25/2015] [Accepted: 06/03/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Misty mesentery appearance is commonly reported in daily practice, usually as a secondary finding of various pathological entities, but sometimes it is encountered as an isolated finding that cannot be attributed to any other disease entity. We aimed to assess the prevalence of cases with incidentally detected idiopathic misty mesentery on computed tomography (CT) and to summarize the pathologies leading to this appearance. METHODS Medical records and initial and follow-up CT features of patients with misty mesentery appearance between January 2011 and January 2013 were analysed. The study included cases with no known cause of misty mesentery according to associated CT findings, clinical history, or biochemical manifestations, and excluded patients with diseases known to cause misty mesentery, lymph nodes greater than a short-axis diameter of 5 mm, discrete mesenteric masses, or bowel wall thickening. RESULTS There were a total of 561 patients in whom misty mesentery appearance was depicted on abdominopelvic CT scans. A total of 80 cases were found to have isolated incidental idiopathic misty mesentery, giving a prevalence of 7%. The common indication for CT examination was abdominal pain. There was a slight female predominance (51.3%). 67.5% of all patients were classified as obese and 17.5% as overweight. CONCLUSIONS The results of the present study show that idiopathic incidental misty mesentery appearance has a significant prevalence. Also, the high body mass index of these patients and the growing evidence of obesity-induced inflammatory changes in adipose tissue are suggestive of an association between obesity and misty mesentery appearance on CT.
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Affiliation(s)
- Ebru Unlu
- Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey.
| | - Nazan Okur
- Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mehtap Beker Acay
- Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Emre Kacar
- Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Serife Ozdinc
- Department of Emergency Medicine, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Cinar Balcik
- Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Ozlem Turksoy Tokgoz
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
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114
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Mesenteric panniculitis: systematic review of cross-sectional imaging findings and risk of subsequent malignancy. Eur Radiol 2016; 26:4531-4537. [PMID: 27048526 PMCID: PMC5101267 DOI: 10.1007/s00330-016-4298-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022]
Abstract
Objectives Systematic review to determine any association between imaging features of idiopathic mesenteric panniculitis (MP) and subsequent malignancy. Methods Two researchers searched primary literature independently for imaging studies of MP. They extracted data focusing on methodology for unbiased patient accrual and capability to determine a link between MP and subsequent malignancy. They noted imaging features of MP. Data were accrued and meta-analysis intended. Results Fourteen of 675 articles were eligible; 1,226 patients. Only three (21 %) accrued patients prospectively. Twelve (86 %) studies described CT features. Follow-up varied widely; 1 month to 8 years. Prevalence of MP was influenced by accrual: 0.2 % for keyword search versus 1.7 % for consecutive series. Accrual bias affected nine (64 %) studies. 458 (38 %) of 1,209 patients had malignancy at accrual but varied widely (8–89 %), preventing meta-analysis. Sixty (6.4 %) of 933 patients developed new malignancy subsequently, also varying widely (0–11 %). Of just four studies that determined the proportion of unselected, consecutive patients with MP developing subsequent malignancy, three were retrospective and the fourth excluded patients with lymphadenopathy, likely excluding patients with MP. Conclusion Studies were heterogeneous, with biased accrual. No available study can determine an association between MP and subsequent malignancy with certainty. Key Points • Our systematic review of mesenteric panniculitis found that imaging studies were biased. • Spectrum and recruitment bias was largely due to retrospective study designs. • No study could confirm a certain link between mesenteric panniculitis and subsequent malignancy. • Excessive methodological heterogeneity precluded meaningful meta-analysis. • High-quality research linking mesenteric panniculitis imaging features and subsequent malignancy is needed.
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115
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Cross AJ, McCormick JJ, Griffin N, Dixon L, Dobbs B, Frizelle FA. Malignancy and mesenteric panniculitis. Colorectal Dis 2016; 18:372-7. [PMID: 26467030 DOI: 10.1111/codi.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/30/2015] [Indexed: 02/08/2023]
Abstract
AIM Mesenteric panniculitis (MP) is a chronic inflammatory process of the small bowel mesentery that has been reported in conjunction with malignancy. The objectives of the present study were to identify the frequency and type of cancers that may coexist with MP and whether these can be seen on the initial diagnostic computerised tomography (CT). METHOD A prospective database was kept of patients diagnosed with MP in the Canterbury region of New Zealand between 1 January 2003 and 31 December 2014. CT scans were independently reviewed. Clinical records were reviewed and family doctors were contacted for additional information. RESULTS There were 302 patients with possible MP identified and 259 in whom it was confirmed on review. Seventy-eight patients had a diagnosis of malignancy, with 54 having a current cancer (59 total cancers), 33 a past cancer and nine both. Of the 59 current cancers the most common primary sites were colorectum (19), lymph nodes (17), kidney (six) and prostate (four). Fifty-four were at sites included on an abdominal CT scan. At all sites [except prostate (0/4)] there were high rates of detection on CT with 44/54 cancers visible including 20/23 gastrointestinal tract, 14/17 lymphomas and 9/9 non-prostate urogenital tract malignancies. Six people were subsequently diagnosed with cancer after the index CT. CONCLUSION When MP occurs in association with malignancy, the commonest primary sites are large bowel, the lymph nodes and the urogenital tract. In those with MP on imaging, any cancer except prostate can usually be seen on the index CT. Further extensive investigation in asymptomatic patients is therefore likely to be of low yield.
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Affiliation(s)
- A J Cross
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - J J McCormick
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - N Griffin
- Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - L Dixon
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - B Dobbs
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - F A Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
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Taffel MT, Khati NJ, Hai N, Yaghmai V, Nikolaidis P. De-misty-fying the mesentery: an algorithmic approach to neoplastic and non-neoplastic mesenteric abnormalities. ACTA ACUST UNITED AC 2016; 39:892-907. [PMID: 24633598 DOI: 10.1007/s00261-014-0113-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mesenteric abnormalities are often incidentally discovered on cross-sectional imaging performed during daily clinical practice. Findings can range from the vague "misty mesentery" to solid masses, and the possible etiologic causes encompass a wide spectrum of underlying pathologies including infectious, inflammatory, and neoplastic processes. Unfortunately, the clinical and imaging findings are often non-specific and may overlap. This article discusses the various diseases that result in mesenteric abnormalities. It provides a framework to non-invasively differentiate these entities, when possible.
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Affiliation(s)
- Myles T Taffel
- Department of Radiology, The George Washington University Hospital, 900 23rd St, NW, Washington, DC, 20037, USA,
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117
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Tavares Pereira JP, Romão V, Eulálio M, Jorge R, Breda F, Calretas S, Leitão S, Eugénio G, Santos R, Carvalho A. Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:55-9. [PMID: 26848804 PMCID: PMC4743678 DOI: 10.12659/ajcr.896145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. CASE REPORT Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65 ± 9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. CONCLUSIONS Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community. Furthermore, despite the small sample size, we describe a possible association between glucose metabolism impairment and sclerosing mesenteritis.
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Affiliation(s)
| | - Vera Romão
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Eulálio
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rita Jorge
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Breda
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Suzana Calretas
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Leitão
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gisela Eugénio
- Department of Rheumatology, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Santos
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
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Avincsal MO, Otani K, Kanzawa M, Fujikura K, Jimbo N, Morinaga Y, Hirose T, Itoh T, Zen Y. Sclerosing mesenteritis: A real manifestation or histological mimic of IgG4-related disease? Pathol Int 2016; 66:158-163. [PMID: 26811214 DOI: 10.1111/pin.12386] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/06/2016] [Indexed: 12/24/2022]
Abstract
We present three cases of sclerosing mesenteritis and review the literature to learn whether or not sclerosing mesenteritis is an IgG4-related disease (IgG4-RD). Our patients were all adult males. Their mesenteric masses ranged from 6.5 to 14.5 cm in the greatest diameter. Tissue specimens showed moderate to severe lymphoplasmacytic infiltration with occasional eosinophils against a background of irregular fibrosis. Both obliterative phlebitis and storiform fibrosis were noted in all cases. IgG4+ plasma cells were moderately increased in number (46 to 85 cells/high-power field). However, unlike IgG4-RD, the IgG4+/IgG+ plasma cell ratio was <40% (28% to 35%). Serum IgG4 concentrations were also within the normal range (43.2 to 105 mg/dL; normal range <135 mg/dL). Two biopsy cases showed spontaneous regression on imaging approximately 5 months later. No sclerosing conditions were found in other organs. The literature review identified 11 additional cases of sclerosing mesenteritis with IgG4+ plasma cell infiltration. However, conclusive cases with four characteristic features (high serum IgG4 levels, tissue IgG4 elevation, multi-organ involvement, and effective response to glucocorticoid therapy) have never been reported. In conclusion, although sclerosing mesenteritis shares histological features with IgG4-RD, most cases are less likely to be IgG4-related. IgG4-RD seemingly seldom, if ever, affects this anatomical site.
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Affiliation(s)
- Mehmet Ozgur Avincsal
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Otolaryngology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Otani
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maki Kanzawa
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Pathology, Kitaharima Medical Center, Ono, Japan
| | - Kohei Fujikura
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukiko Morinaga
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Pathology, Hyogo Cancer Center, Akashi, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
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Lee SJ, Park CK, Yang WI, Kim SK. IgG4-Related Sclerosing Mesenteritis. J Pathol Transl Med 2016; 50:309-11. [PMID: 26755359 PMCID: PMC4963968 DOI: 10.4132/jptm.2015.12.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Seok Joo Lee
- Department of Pathology, Yonsei University Medical Center, Seoul, Korea
| | - Cheol Keun Park
- Department of Pathology, Yonsei University Medical Center, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University Medical Center, Seoul, Korea
| | - Sang Kyum Kim
- Department of Pathology, Yonsei University Medical Center, Seoul, Korea
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Masulovic D, Jovanovic M, Ivanovic A, Stojakov D, Micev M, Stevic R, Filipovic A, Galun D. Sclerosing Mesenteritis Presenting as a Pseudotumor of the Greater Omentum. Med Princ Pract 2016; 25:93-5. [PMID: 26436663 PMCID: PMC5588320 DOI: 10.1159/000441454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim was to demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma. CLINICAL PRESENTATION AND INTERVENTION A 45-year-old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well- demarcated tumor in his left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive of liposarcoma. Intraoperative findings showed a tumor arising from the greater omentum. The tumor was completely removed, and histopathology confirmed a pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy. CONCLUSION This case showed that a pseudotumorous type of sclerosing mesenteritis should be considered in the differential diagnosis of the mesenteric tumors.
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Affiliation(s)
- Dragan Masulovic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
| | | | - Aleksandar Ivanovic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
| | - Dejan Stojakov
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, HPB Unit, Belgrade, Serbia
| | - Marjan Micev
- Department of Pathology, Clinic for Digestive Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Ruza Stevic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
- *Ruza Stevic, Center of Radiology and MRI, Clinical Center of Serbia, Pasterova 2, RS–11000 Belgrade (Serbia), E-Mail
| | | | - Danijel Galun
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, HPB Unit, Belgrade, Serbia
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Kakimoto K, Inoue T, Toshina K, Yorifuji N, Iguchi M, Fujiwara K, Kojima Y, Okada T, Nouda S, Kawakami K, Abe Y, Takeuchi T, Egashira Y, Higuchi K. Multiple Mesenteric Panniculitis as a Complication of Sjögren's Syndrome Leading to Ileus. Intern Med 2016; 55:131-4. [PMID: 26781011 DOI: 10.2169/internalmedicine.55.5407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mesenteric panniculitis (MP) is a benign fibroinflammatory process characterized by the presence of fat necrosis, chronic inflammation and fibrosis in the mesentery. Although various causal factors, such as malignancy, chronic inflammatory conditions and autoimmune processes, have been identified, the precise etiology remains unknown. We herein report a rare case of MP accompanying Sjögren's syndrome in which a mass lesion and intestinal stenosis were observed simultaneously. This condition led to ileus, which was effectively treated using prednisolone.
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Affiliation(s)
- Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical College, Japan
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122
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Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features. ACTA ACUST UNITED AC 2015; 40:626-42. [PMID: 25189130 DOI: 10.1007/s00261-014-0232-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.
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123
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Suarez Acosta CE, Romero Fernandez E, Calvo Manuel E. Mesenteric panniculitis: A controversial entity. Many unanswered questions. Eur J Intern Med 2015; 26:e67-8. [PMID: 26388255 DOI: 10.1016/j.ejim.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Enrique Suarez Acosta
- Internal Medicine Department, University Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, C. P: 28040 Madrid, Spain.
| | - Esperanza Romero Fernandez
- Internal Medicine Department, University Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, C. P: 28040 Madrid, Spain
| | - Elpidio Calvo Manuel
- Internal Medicine Department, University Hospital Clinico San Carlos, C/ Profesor Martin Lagos s/n, C. P: 28040 Madrid, Spain
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125
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Mitchell A, Caty V, Bendavid Y. Massive mesenteric panniculitis due to fibromuscular dysplasia of the inferior mesenteric artery: a case report. BMC Gastroenterol 2015; 15:71. [PMID: 26100669 PMCID: PMC4477478 DOI: 10.1186/s12876-015-0303-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/17/2015] [Indexed: 02/01/2023] Open
Abstract
Background Fibromuscular dysplasia (FMD) is a nonatheromatous, noninflammatory arterial disorder of unknown etiology resulting in vessel stenosis and/or aneurysm formation. The renal and cephalocervical (mainly carotid arteries) arterial beds are classically involved; involvement of visceral arteries is rare. Mesenteric panniculitis (MP) is an inflammatory process of mesenteric fat considered to be of unknown etiology. The majority of cases involve the small bowel mesentery; colorectal MP is rare. To our knowledge, no example of MP due to FMD has been described. Case presentation A 52 year old man presented with steadily worsening lower abdominal pain. Investigation revealed ischemic rectosigmoid mucosa associated with a large mesenteric mass of unknown nature. Angiography showed the disease was limited to the distribution of the inferior mesenteric artery. Subsequent symptoms of large bowel obstruction necessitated a left hemicolectomy. Pathologic examination showed bowel wall necrosis and massive panniculitis of the rectosigmoid due to FMD. Subsequent angiographic imaging of other vascular beds was negative. Conclusions Several features of this case are noteworthy: FMD limited to the inferior mesenteric artery has not been previously reported, FMD has not previously been implicated as a cause of MP, and the massive extent of panniculitis. An accompanying literature review of cases of visceral FMD, traditionally believed to almost exclusively affect females, highlights a greater than anticipated number of males (33 %), and a gender difference regarding concomitant involvement of cephalocervical and/or renal vascular beds (32 % in males versus 80 % in females). The latter observation may have implications regarding the value of radiologic screening of other vascular beds, particularly in asymptomatic males, in patients presenting with visceral artery FMD. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0303-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew Mitchell
- Departments of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal, QC, H1T 2M4, Canada.
| | - Véronique Caty
- Department of Radiology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal, QC, H1T 2M4, Canada.
| | - Yves Bendavid
- Department of Surgery, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal, QC, H1T 2M4, Canada.
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Tierney C, Dinkelspiel HE, Bass AR, Cimic A, Katzen J, Holcomb K. Sclerosing mesenteritis mimics gynecologic malignancy. Gynecol Oncol Rep 2015; 12:49-51. [PMID: 26076158 PMCID: PMC4442657 DOI: 10.1016/j.gore.2015.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/19/2015] [Indexed: 12/19/2022] Open
Abstract
•Sclerosing mesenteritis, and associated inflammatory conditions of the retroperitoneum, may mimic malignancy or infection.•Attempted surgical excision of sclerosing mesenteritis and other retroperitoneal conditions often lead to a morbid and unsuccessful surgery.•These conditions are immune-mediated, and respond remarkably well to immunosuppression.
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Affiliation(s)
- Christina Tierney
- Department of Obstetrics & Gynecology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
- Corresponding author at: 525 East 68th St, J-130, New York, NY 10021, United States.
| | - Helen E. Dinkelspiel
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Anne R. Bass
- Department of Medicine, Weill Cornell Medical College - Hospital for Special Surgery, United States
| | - Adela Cimic
- Department of Pathology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Janine Katzen
- Department of Radiology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Kevin Holcomb
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
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Alhazzani W, Al-Shamsi HO, Greenwald E, Radhi J, Tse F. Chronic abdominal pain secondary to mesenteric panniculitis treated successfully with endoscopic ultrasonography-guided celiac plexus block: A case report. World J Gastrointest Endosc 2015; 7:563-566. [PMID: 25992196 PMCID: PMC4436925 DOI: 10.4253/wjge.v7.i5.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/21/2014] [Accepted: 03/05/2015] [Indexed: 02/05/2023] Open
Abstract
Mesenteric panniculitis is a chronic illness that is characterized by fibrosing inflammation of the mesenteries that can lead to intractable abdominal pain. Pain control is a crucial component of the management plan. Most patients will improve with oral corticosteroids treatment, however, some patients will require a trial of other immunosuppressive agents, and a minority of patients will continue to have refractory disease. Endoscopic ultrasound guided celiac plexus block is used frequently to control abdominal pain in patients with pancreatic pathology. To our knowledge there are no case reports describing its use in mesenteric panniculitis patients with refractory abdominal pain.
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128
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Wassilew N, Ciaffi L, Calmy A. Mesenterial involvement of Mycobacterium genavense infection: hard to find, hard to treat. BMJ Case Rep 2015; 2015:bcr-2014-208241. [PMID: 25976189 DOI: 10.1136/bcr-2014-208241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium genavense is a rare pathogen affecting severely immunosuppressed patients. We report the case of persistent relapsing M. genavense infection in a 48-year-old African man with a positive diagnosis of HIV infection. Despite being under effective antiretroviral therapy with partial immune reconstitution, he developed irreversible long-term abdominal complications, possibly due to persistent M. genavense infection and sustained inflammation. Case management consists of individual risk assessment, close follow-up and personalised treatment strategies concerning the duration of antimycobacterial therapy and early application of steroids. Patients with profound immunosuppression, a high viral load at HIV diagnosis and a high burden of M. genavense, appear to be at higher risk. The pathogenicity of this complication is not well known and its optimal management has still to be determined.
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Affiliation(s)
- Nasstasja Wassilew
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Laura Ciaffi
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
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Das KK, Clayton EF, Kochman ML. An unusual case of nausea and vomiting. Gastroenterology 2015; 148:515-6. [PMID: 25622789 DOI: 10.1053/j.gastro.2014.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Koushik K Das
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica F Clayton
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L Kochman
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
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Sideras PA, Patil V, Li Z, Heiba S, Kostakoglou L. PET–CT of mesenteric panniculitis: A potential confounder of lymphoma. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.
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132
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Sun MZ, Tang XH, Wang CH, Yan Z, Zhou CJ, Sun H. Research progress in diagnosis and treatment of mesenteric panniculitis. Shijie Huaren Xiaohua Zazhi 2014; 22:4276-4280. [DOI: 10.11569/wcjd.v22.i28.4276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesenteric panniculitis is a chronic non-specific inflammatory disorder which involves the mesenteric adipose tissue. It is a rare benign condition that is difficult to diagnose and is easily misdiagnosed. This paper focuses on the epidemiology, pathogenesis, clinical and pathological manifestations, imaging, diagnosis and differential diagnosis, treatment and prognosis of mesenteric panniculitis, with an aim to improve the knowledge of the disease and the level of treatment.
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133
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van Putte-Katier N, van Bommel EFH, Elgersma OE, Hendriksz TR. Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up. Br J Radiol 2014; 87:20140451. [PMID: 25271412 DOI: 10.1259/bjr.20140451] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine prevalence, clinicoradiological characteristics and outcome of patients with mesenteric panniculitis (MP) in a large hospital-based population. METHODS Consecutive abdominal CT examinations of 3820 patients were evaluated for MP. Clinical characteristics, therapy and outcome of patients with MP were evaluated during a 5-year follow-up period. A matched pair analysis was performed to further investigate the relation between MP and malignancy. RESULTS 94 (2.5%) patients with MP were identified (mean age, 66.6 ± 11.2 years, 70.2% male). MP coexisted with malignancy (especially prostatic carcinoma) in 48.9% of patients, and this was slightly but significantly higher than in age- and sex-matched control patients (n = 188, 46.3%). In 48 patients, MP was presumed to be idiopathic. The most frequent presenting symptom was pain (54.3%). Laboratory findings revealed increased acute-phase reactants in half of the patients with MP. CT findings included increased density of mesenterial fat (mean, -56.8 ± 10.8 HU), fat ring sign, tumoural pseudocapsule and small soft-tissue nodules. Patients with MP (14.6%) developed significantly more malignancies during a 5-year follow-up than did the control group (6.9%). One patient was treated with prednisone without satisfactory response. CONCLUSION The prevalence of MP in this study was 2.5%. In most patients, radiologic features included increased mesenteric fat density, fat ring sign and small soft-tissue nodules. MP was associated with a significant higher prevalence of coexisting malignancies and a higher prevalence of future cancer development. ADVANCES IN KNOWLEDGE A more accurate prevalence of MP on CT is demonstrated. An underlying malignancy may play a role.
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Kim EJ, Kim EY, Song JE, Lee HC, Bae GH, Oh HK, Lee TS. [A case of IgG4-related sclerosing mesenteritis associated with Crohn's disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:176-82. [PMID: 24651591 DOI: 10.4166/kjg.2014.63.3.176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.
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Affiliation(s)
- Eui Jung Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea
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A case of sclerosing mesenteritis with spontaneous resolution with steroid therapy. Clin J Gastroenterol 2014; 7:346-8. [DOI: 10.1007/s12328-014-0497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
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136
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Ezhapilli SR, Moreno CC, Small WC, Hanley K, Kitajima HD, Mittal PK. Mesenteric masses: Approach to differential diagnosis at MRI with histopathologic correlation. J Magn Reson Imaging 2014; 40:753-69. [DOI: 10.1002/jmri.24690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/09/2014] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sajeev R. Ezhapilli
- Department of Radiology & Imaging Sciences; Emory University School of Medicine; Atlanta Georgia USA
| | - Courtney Coursey Moreno
- Department of Radiology & Imaging Sciences; Emory University School of Medicine; Atlanta Georgia USA
| | - William C. Small
- Department of Radiology & Imaging Sciences; Emory University School of Medicine; Atlanta Georgia USA
| | - Krisztina Hanley
- Department of Pathology; Emory University School of Medicine; Atlanta Georgia USA
| | - Hiroumi D. Kitajima
- Department of Radiology & Imaging Sciences; Emory University School of Medicine; Atlanta Georgia USA
| | - Pardeep K. Mittal
- Department of Radiology & Imaging Sciences; Emory University School of Medicine; Atlanta Georgia USA
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137
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Martín-Mateos RM, Moreira-Vicente VF, Burdaspal-Moratilla A, Gallego-Rivera JI. [Mesenteric panniculitis as a cause of chronic abdominal pain]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:297-299. [PMID: 24314792 DOI: 10.1016/j.gastrohep.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Rosa M Martín-Mateos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España.
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138
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139
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Winant AJ, Vora A, Ginter PS, Levine MS, Brylka DA. More than just metastases: a practical approach to solid mesenteric masses. ACTA ACUST UNITED AC 2014; 39:605-21. [DOI: 10.1007/s00261-014-0090-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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140
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Rumman N, Rumman G, Sharabati B, Zagha R, Disi N. Mesenteric panniculitis in a child misdiagnosed as appendicular mass: a case report and review of literature. SPRINGERPLUS 2014; 3:73. [PMID: 25191632 PMCID: PMC4153878 DOI: 10.1186/2193-1801-3-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/31/2014] [Indexed: 12/21/2022]
Abstract
Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.
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Affiliation(s)
- Nisreen Rumman
- Department of Pediatrics, Makassed Hospital, Jerusalem, Palestine
| | - George Rumman
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
| | | | - Rami Zagha
- Department of Pathology, Al-Najah National University, Nablus, Palestine
| | - Nimer Disi
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
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141
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Extrapancreatic findings of IgG4-related disease. Clin Radiol 2014; 69:209-18. [DOI: 10.1016/j.crad.2013.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/18/2013] [Accepted: 09/23/2013] [Indexed: 01/06/2023]
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142
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Hasosah MY, Satti MB, Yousef YA, Alzahrani DM, Almutairi SA, Alsahafi AF, Sukkar GA, Alzaben AA. IgG4-related sclerosing mesenteritis in a 7-year-old Saudi girl. Saudi J Gastroenterol 2014; 20:385-8. [PMID: 25434322 PMCID: PMC4271016 DOI: 10.4103/1319-3767.145333] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare, benign inflammatory disorder of unknown etiology, affecting the membranes of the digestive tract that involves lymphoplasmacytic inflammation, fat necrosis, and fibrosis of the mesentery. We report a child patient with a history of recurrent abdominal pain and fever who was found to have an intra-abdominal mass suspicious for malignancy. A tissue biopsy revealed the diagnosis of SM associated with IgG4-related systemic disease. The patient is currently maintained on 5 mg prednisone daily and no recurrence of symptoms was noted during the 24-month follow-up period. We emphasize, therefore, that SM can present clinical challenges and the presence of SM should cue clinicians to search for other coexisting autoimmune disorders that can have various outcomes.
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Affiliation(s)
- Mohammed Y. Hasosah
- Department of Pediatric Gastroenterology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia,Address for correspondence: Dr. Mohammed Hasosah, Department of Pediatric Gastroenterology, Assistant Professor of Pediatric, King Saud Bin Abdulaziz University for Health Sciences/Pediatric Consultant Gastroenterologist, King Abdul-Aziz Medical City, National Guard Hospital, Jeddah, PO Box: 8202, Jeddah 21482. Saudi Arabia. E-mail:
| | - Mohamed B. Satti
- Department of Pathology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Yasmin A. Yousef
- Department of Pediatric Surgery, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Daifullah M. Alzahrani
- Department of Pediatric Immunology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Sajdi A. Almutairi
- Department of Pediatric Rheumatology King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Ashraf F. Alsahafi
- Department of Pediatric Gastroenterology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Ghassan A. Sukkar
- Department of Pediatric Gastroenterology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
| | - Abdullah A. Alzaben
- Department of Pediatric Gastroenterology (Riyad), King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia
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143
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Al Zahrani H, Kyoung Kim T, Khalili K, Vlachou P, Yu H, Jang HJ. IgG4-related disease in the abdomen: a great mimicker. Semin Ultrasound CT MR 2013; 35:240-54. [PMID: 24929264 DOI: 10.1053/j.sult.2013.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IgG4-related disease is a systemic disorder that can involve various abdominal organs. Abdominal manifestations include autoimmune pancreatitis, sclerosing cholangitis, gallbladder pseudotumours, multifocal renal abnormalities, retroperitoneal fibrosis, and sclerosing mesenteritis. Radiological appearances of the IgG4-related disease often resemble malignant tumors and other inflammatory processes, potentially leading to unnecessary invasive procedures. Moreover, a timely diagnosis of IgG4-related disease leads to an effective treatment with steroids. Therefore, it is important to understand the spectrum of imaging manifestations of IgG4-related disease and their differentiating features from other diagnoses.
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Affiliation(s)
- Hassan Al Zahrani
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Korosh Khalili
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Paraskevi Vlachou
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Hojun Yu
- Department of Medical Imaging, QE2 Hospital, Grande Prairie, Alberta, Canada
| | - Hyun-Jung Jang
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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144
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Parra-Buitrago A, Valencia-Zuluaga NA, Rivera-Echeverry JA, Contreras-Ramírez M, Vélez-Hoyos A. [Idiopathic sclerosing mesenteritis in the pediatric patient: a case report]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:255-7. [PMID: 24290726 DOI: 10.1016/j.rgmx.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/26/2022]
Affiliation(s)
- A Parra-Buitrago
- Residentes de Pediatría, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | | | - J A Rivera-Echeverry
- Servicio de Gastroenterología y Endoscopia, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - M Contreras-Ramírez
- Servicio de Gastroenterología y Endoscopia, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - A Vélez-Hoyos
- Servicio de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia
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145
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Gögebakan Ö, Albrecht T, Osterhoff M, Reimann A. Is mesenteric panniculitis truely a paraneoplastic phenomenon? A matched pair analysis. Eur J Radiol 2013; 82:1853-9. [DOI: 10.1016/j.ejrad.2013.06.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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146
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Rosales JF, Geiger XJ, Gómez V. Don't blame it on the scar tissue. Gastroenterology 2013; 145:728, 914-5. [PMID: 23969176 DOI: 10.1053/j.gastro.2013.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/05/2013] [Indexed: 12/02/2022]
Affiliation(s)
- Javier F Rosales
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida
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147
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Parra-Buitrago A, Valencia-Zuluaga N, Rivera-Echeverry J, Contreras-Ramírez M, Vélez-Hoyos A. Idiopathic sclerosing mesenteritis in the pediatric patient: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2013. [DOI: 10.1016/j.rgmxen.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVE IgG4-related disease was not recognized as a specific clinical entity until 2003 when extrapancreatic lesions were reported in patients with autoimmune pancreatitis. IgG4-related disease is characterized by elevated serum IgG4 levels and infiltration of the target organ by IgG4-positive plasma cells. The complete gamut of visceral involvement is still being outlined. The purpose of this article is to highlight the plethora of lesions under the spectrum of IgG4-related disease of the abdomen and pelvis, describe their imaging appearances on multimodality cross-sectional imaging, and discuss the differential diagnoses. CONCLUSION It is important for radiologists to recognize the multiorgan involvement and few classic features of IgG4-related disease that often tend to simulate malignancy.
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149
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Fujita A, Sakai O, Chapman MN, Sugimoto H. IgG4-related disease of the head and neck: CT and MR imaging manifestations. Radiographics 2013; 32:1945-58. [PMID: 23150850 DOI: 10.1148/rg.327125032] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Immunoglobulin G4 (IgG4)-related disease is a recently established systemic disease that commonly involves the head and neck, including the salivary glands, lacrimal glands, orbits, thyroid gland, lymph nodes, sinonasal cavities, pituitary gland, and larynx. Although the definitive diagnosis of IgG4-related disease requires histopathologic analysis, elevated serum IgG4 levels are helpful in making the diagnosis. Because of the proposed clinical diagnostic criteria for this disease, cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance (MR) imaging play an important diagnostic role. CT and MR imaging findings of IgG4-related disease are usually nonspecific. At CT, involved organs may demonstrate enlargement or decreased attenuation; at T2-weighted MR imaging, they may have relatively low signal intensity owing to their increased cellularity and amount of fibrosis. Some pathologic entities involving the head and neck are now considered to be part of the IgG4-related disease spectrum, including idiopathic orbital inflammatory syndrome (inflammatory pseudotumor), orbital lymphoid hyperplasia, Mikulicz disease, Küttner tumor, Hashimoto thyroiditis, Riedel thyroiditis, and pituitary hypophysitis. Because involvement of multiple sites is common in IgG4-related disease, radiologists should be familiar with manifestations of this systemic process outside the head and neck, in organs such as the pancreas, bile ducts, gallbladder, kidneys, retroperitoneum, mesentery, lungs, gastrointestinal tract, and blood vessels. Moreover, IgG4-related disease usually demonstrates a dramatic response to corticosteroid therapy, and radiologists should be familiar with its clinical and imaging manifestations to avoid a delay in diagnosis or unnecessary invasive interventions.
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Affiliation(s)
- Akifumi Fujita
- Department of Radiology, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
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150
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Smith ZL, Sifuentes H, Deepak P, Ecanow DB, Ehrenpreis ED. Relationship between mesenteric abnormalities on computed tomography and malignancy: clinical findings and outcomes of 359 patients. J Clin Gastroenterol 2013; 47:409-414. [PMID: 23188076 DOI: 10.1097/mcg.0b013e3182703148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric abnormalities are detected on abdominal computed tomography (CT) performed for various indications. GOALS Determine the risk of malignancy on follow-up of patients with these abnormalities without a preexisting malignancy. STUDY Data were collected on all patients at NorthShore University HealthSystem with abdominal CT scan reports of mesenteric abnormalities labeled as "panniculitis" from January 2005 to April 2010. RESULTS Three hundred fifty-nine patients were identified, 81 (22.6%) had a known malignancy at the time of the index abdominal CT scan. Nineteen (6.8%) of the 278 had a new diagnosis of malignancy on evaluation of the findings of the index CT scan. Among the 240 (86.33%) that did not have a notation of the abnormality in their medical record, 11 (4.58%) developed a malignancy during the study period. Sixty-eight of the 248 (24.46%) without a known malignancy had diseases associated with mesenteric abnormalities. The presence of these were associated with a reduction in the likelihood that the abnormalities are associated with new or delayed diagnosis of a malignancy (odds ratio, 0.197; 95% confidence interval, 0.0045-0.8501; P=0.013). Progression of underlying malignancy was unlikely in those where the mesenteric abnormalities did not worsen in appearance on follow-up CT scans (odds ratio, 0.03268; 95% confidence interval, 0.0028-0.3761; P=0.0061). CONCLUSIONS In the presence of an underlying disease associated with these findings, the subsequent finding of a malignancy is less likely. In addition, neglect of these findings may result in delayed diagnosis of cancer.
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Affiliation(s)
- Zachary L Smith
- Department of Medicine, University of Chicago (North Shore), North Shore University Health System, Evanston, IL, USA
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