CT and MRI manifestations of intraabdominal panniculitis

A case of mesenteric panniculitis: multiple involvement of the emergency department before final diagnosis and appropriate treatment

Mesenteric panniculitis is a rare disease leading to recurrent acute abdominal pain, whose recognition is important to avoid any unwarranted aggressive surgery. A case of this condition is described. The patient, a 73-year-old man, attended our emergency room with acute abdominal pain, fever and prolonged partial thromboplastin time. He had a history of recurrent emergency department access and complained of the same rapidly reversible clinical picture. Findings at abdominal computed tomography and at diagnostic laparascopy (including histology of a biopsy) helped reach a correct diagnosis and treatment. In this brief report from literature analysis, we present diagnosis and treatment of mesenteric panniculitis from what is known so far. Finally, we briefly discuss some peculiar pathogenesis and hypothesis.

[Etiologic spectrum of mesenteric panniculitis: report of 7 cases]

OBJECTIVE

Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy.

METHODS

A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases.

RESULTS

Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations.

CONCLUSION

Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.

Role of adipose tissue as an inflammatory organ in human diseases

Reviews on the inflammatory role of adipose tissue outside the field of metabolism are rare. There is increasing evidence provided by numerous basic research studies from nearly all internal medicine subspecializations that adipocytes and adipocytokines are involved in primary inflammatory processes and diseases. Therefore, it is the aim of the present review to discuss and to summarize the current knowledge on the inflammatory role of adipocytokines and special types of regional adipocytes such as retroorbital, synovial, visceral, subdermal, peritoneal, and bone marrow adipocytes in internal medicine diseases. Future clinical and therapeutic implications are discussed.

From the archives of the AFIP: benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation

Mesenteric fibromatosis, sclerosing mesenteritis, inflammatory pseudotumor, and extrapleural solitary fibrous tumor constitute a loosely associated group of benign fibrous tumors and tumorlike lesions of the mesentery. These lesions are linked histologically by the presence of fibroblasts or fibrosis and anatomically by their location within the mesentery. Although rare, and distinctly different in pathogenesis and biologic behavior, these fibrous lesions have pathologic and radiologic features that overlap with one another and with more common neoplastic and nonneoplastic lesions of the mesentery. Mesenteric fibromatosis is a locally aggressive, benign proliferative process that may occur sporadically or in association with familial adenomatous polyposis. It most frequently manifests as a focal mesenteric mass and may simulate lymphoma, metastatic disease, or a soft-tissue sarcoma. Sclerosing mesenteritis is a rare idiopathic disorder that most commonly produces a stellate mass within the mesentery and should be differentiated from metastatic disease, specifically metastatic carcinoid, because it frequently responds to conservative or medical management. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) is a benign, chronic inflammatory disorder of unknown cause that manifests as a solid mesenteric mass, indistinguishable from malignancy. Extrapleural solitary fibrous tumor is a tumor of submesothelial origin that is identical to the solitary fibrous tumor of the pleura. When located in the mesentery or peritoneal cavity, extrapleural solitary fibrous tumor has an imaging pattern that must be differentiated from metastatic disease, soft-tissue sarcomas, and other benign and malignant neoplasms of the mesentery and peritoneum. Knowledge of this group of benign fibrous tumors and tumorlike lesions of the mesentery is important in the preoperative evaluation of a mesenteric mass.

Mechanisms of disease: adipocytokines and visceral adipose tissue--emerging role in intestinal and mesenteric diseases

Adipose tissue has long been regarded as a passive type of connective tissue that stores energy as triglycerides and releases energy as free fatty acids, however, this point of view has now changed. The wide variety of products expressed and secreted by adipose tissue, such as adiponectin, leptin, and resistin, mean that the total adipose tissue mass can be defined as a real endocrine organ. The anatomic, metabolic and biochemical characteristics of visceral adipose tissue make it interesting in the context of intestinal and mesenteric diseases. These characteristics include increased lipolysis, venous drainage via the portal vein and local glucocorticoid excess owing to the specific expression of 11-beta-hydroxysteroid-dehydrogenase type 1. In this review, the role of the visceral adipose tissue and its secretory products in intestinal and mesenteric diseases is systematically reviewed, with special focus on 'creeping fat' in Crohn's disease and mesenteric panniculitis.

Mesenteric panniculitis versus pancreatitis: a computed tomography diagnostic dilemma

A case of mesenteric panniculitis is described in a patient with CT features mimicking pancreatitis. Emphasis is on the important CT features for accurate diagnosis.

Idiopathic mesenteric and omental steatitis in a dog

A 2-year-old Miniature Dachshund was admitted to the hospital because of fever, frequent vomiting, and watery diarrhea. An intra-abdominal mass and a gastric ulcer were detected. At laparotomy, the omentum was yellow but not icteric, irregularly thickened, and fragile, and a large mass involving the root of the mesentery and the gastrosplenic ligament was found. The histopathologic diagnosis was steatitis, and the dog was treated with prednisolone and cyclosporine for 2.5 years. After 1.5 years, the abdominal mass was not detectable. The dog died suddenly from perforation of the small intestine caused by a foreign body. Necropsy revealed severe adhesions between portions of the small intestine, and cicatrization of the mesentery. Cause of the mesenteric and omental steatitis was not apparent.

Multiple nodular metastases in mesenteric panniculitis by uterine papillary serous adenocarcinoma (UPSC): CT appearance of a case

Intra-abdominal panniculitis is a thickening of the mesentery of the small/large intestine due to infiltration of lipid-laden macrophages associated with a variable amount of fibrosis. This condition is rarely associated with malignant neoplasms. We report the computed tomography (CT) findings of a patient treated for uterine papillary serous adenocarcinoma (UPSC). She had mesenteric panniculitis where metastatic tumor nodules implanted. This was the only intraperitoneal recurrence. To our knowledge, no such finding has been reported in the gynecologic and radiologic literature to date. On CT images, the differential diagnosis is with cystic dilatations of mesenteric lymph vessels.