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Kobayashi H, Notohara K, Otsuka T, Kobayashi Y, Ujita M, Yoshioka Y, Suzuki N, Aoyagi R, Ohashi R, Suzuki T. An Autopsy Case of Mesenteric Panniculitis with Massive Pleural Effusions. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:13-20. [PMID: 29298971 PMCID: PMC5763981 DOI: 10.12659/ajcr.905744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric panniculitis (MP) is an idiopathic chronic inflammatory condition of the mesentery. The main symptoms include abdominal pain, abdominal distention, weight loss, fever, nausea, and vomiting. The patients also present with chylous ascites in 14% of the cases and chylous pleural effusion (CPE) in very rare occasions. Despite the previous view of excellent prognosis of MP, two recent papers reported several fatal cases. However, there are still only a few autopsy case reports that describe the macroscopic and histological details of MP cases. CASE REPORT The patient was an 81-year-old Japanese woman. She complained of edema of her lower legs and face, general fatigue, and dyspnea. She was overweight and had type 2 diabetes (T2D). Computerized tomography (CT) demonstrated massive bilateral pleural effusions, with mild pericardial effusion and mild ascites. There was no pulmonary, cardiac or hepatic condition to explain the effusions. However, MP was suspected based on her CT. She gradually deteriorated into respiratory failure. The autopsy revealed CPEs (left 1,300 mL, right 1,400 mL) and MP in the mesentery of the small intestine. Neither neoplasia nor inflammatory conditions other than MP were detected. CONCLUSIONS In rare occasions, patients with MP present with CPE or chylothorax. We thought that a possible mechanism of the CPEs was a diaphragmatic defect. We suspected that being overweight and T2D had an etiological relationship with MP in our patient's case. Adipose tissue of the mesentery is the main focus of MP. We believed that MP would be the best umbrella term of the many synonyms.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki General Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Otsuka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuka Kobayashi
- Department of Oncology, Nagaoka Central Hospital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Naomasa Suzuki
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Core Facility, Niigata University Faculty of Medicine, Niigata City, Niigata, Japan
| | - Toshimitsu Suzuki
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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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: 15] [Impact Index Per Article: 1.9] [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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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: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sclerosing mesenteritis: A rare case of large bowel and rectum involvement. Arab J Gastroenterol 2012; 13:93-6. [PMID: 22980600 DOI: 10.1016/j.ajg.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 08/10/2010] [Accepted: 02/22/2012] [Indexed: 12/25/2022]
Abstract
Sclerosing mesenteritis (SM) is an uncommon non-neoplastic inflammatory process in the mesentery that is seen as a pseudotumour, usually involving the small-bowel mesentery and, less commonly, the mesentery of the large bowel. The disease has two well-established histological types: the acute or sub-acute form known as mesenteric panniculitis and the chronic form known as retractile or SM. Because SM lacks special clinical manifestation and typical signs, the possibility of misdiagnosis is very high. The correct diagnosis of SM depends on pathological examination. Here in, we report a case of a 41-year-old male patient with SM of the large bowel.
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Guettrot-Imbert G, Boyer L, Piette JC, Delèvaux I, André M, Aumaître O. [Mesenteric panniculitis]. Rev Med Interne 2012; 33:621-7. [PMID: 22658529 DOI: 10.1016/j.revmed.2012.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/15/2012] [Indexed: 12/17/2022]
Abstract
Mesenteric panniculitis is a nonspecific inflammatory process affecting the fatty tissue at the root of the mesentery. This term is also used to describe the clinical and imaging findings in this disorder. Mesenteric panniculitis can be a misleading term: it is commonly misused to design an increased density of the mesentery without prejudice regarding the etiology. Pain is the main clinical symptom. Half of the patients are asymptomatic. There is a palpable mass in half of cases. Laboratory tests sometimes reveal an acute phase reaction of varying intensity. Mesenteric panniculitis is suspected when CT scan shows increased density of the mesenteric fat. Nevertheless, only histological examination could establish the diagnosis. Histologic examination may reveal various stages: lipodystrophy (the first stage when fat necrosis is predominant), mesenteric panniculitis (a majority of infiltrating lymphocytes), sclerosing mesenteritis (the end stage when fibrosis is predominant). Histopathologic differential diagnoses are lymphomas, lipomas, liposarcomas that can mimic mesenteric panniculitis on CT scan. Mesenteric panniculitis is associated with various diseases, especially with intra-abdominal inflammatory process. It also can be idiopathic. Rare complications can occur with vascular or digestive tract compressions. Empirical treatment is only useful in symptomatic patients. Colchicine, corticosteroids or immunosuppressive agents can be used. The only interest of surgery is the histological confirmation of the diagnosis. A better understanding of the pathophysiology of the immunoregulatory functions of adipose tissue will improve mesenteric panniculitis management.
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Affiliation(s)
- G Guettrot-Imbert
- Service de médecine interne, CHU de Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand cedex 1, France.
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Bae JH, Kim SH, Ahn SB, Son BK, Jo YJ, Park YS, Jung YM, Chang YS. A Case of Idiopathic Sclerosing Mesenteritis with Retroperitoneal Fibrosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:221-5. [DOI: 10.4166/kjg.2011.58.4.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- June Ho Bae
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Seong Hwan Kim
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Byoung Kwan Son
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Yun Ju Jo
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Young Sook Park
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Yu Min Jung
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Yeon Soo Chang
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
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Viswanathan V, Murray KJ. Idiopathic sclerosing mesenteritis in paediatrics: Report of a successfully treated case and a review of literature. Pediatr Rheumatol Online J 2010; 8:5. [PMID: 20205836 PMCID: PMC2825191 DOI: 10.1186/1546-0096-8-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 01/21/2010] [Indexed: 12/30/2022] Open
Abstract
A 6 year old female with symptoms of small bowel obstruction underwent an exploratory laparotomy which revealed widespread evidence of inflammatory fibrotic adhesions involving the jejunal mesentery. In view of persistent growth failure, chronic anaemia, elevated acute phase reactants and imaging evidence of a diffuse progressive inflammatory process, the child was treated with corticosteroids and methotrexate with complete response. The literature on juvenile idiopathic sclerosing mesenteritis has been reviewed.
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Affiliation(s)
- Vijay Viswanathan
- Department of Pediatric Rheumatology, Princess Margaret Hospital for Children, Perth, WA, Australia.
| | - Kevin J Murray
- Department of Pediatric Rheumatology, Princess Margaret Hospital for Children, Perth, WA, Australia
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Extensive sclerosing mesenteritis of the rectosigmoid colon associated with erosive colitis. Gastroenterol Res Pract 2009; 2009:176793. [PMID: 19365585 PMCID: PMC2667937 DOI: 10.1155/2009/176793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 02/15/2009] [Accepted: 02/20/2009] [Indexed: 11/17/2022] Open
Abstract
Sclerosing mesenteritis is a rare, idiopatic, usually benign, inflammatory process of the mesenteric adipose tissue. The most common site of involvement is the small bowel mesentery. We present a case of sclerosing mesenteritis of the rectosigmoid colon as a cause of severe abdominal pain, abdominal obstruction, and ischemic colic mucosal lesions. Contrast enema, colonoscopy, angiography, and CT were the imaging modalities used. A 20 cm diameter, fibrotic mass causing extensive compression of rectosigmoid colon was found at laparotomy. Histological examination showed extended fibrosis, inflammatory cells infiltration, lipophages, and granulomas within the mesenteric adipose tissue associated with erosive colitis. Clinical presentation and treatment are discussed.
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Akram S, Pardi DS, Schaffner JA, Smyrk TC. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol 2007; 5:589-96; quiz 523-4. [PMID: 17478346 DOI: 10.1016/j.cgh.2007.02.032] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Sclerosing mesenteritis is a rare non-neoplastic disease that affects the small bowel mesentery with chronic fibrosing inflammation. There are few data on the natural history and therapeutic options for this condition. METHODS We performed a retrospective and prospective study to describe the clinical characteristics, therapy, and outcome of all cases of sclerosing mesenteritis diagnosed at the Mayo Clinic, Rochester, from 1982-2005. RESULTS Ninety-two cases were identified; 70% were male, with a median age of 65 years (interquartile range, 55-72). Common presenting symptoms included abdominal pain in 70%, diarrhea in 25%, and weight loss in 23%. Treatment included medical therapy alone in 26%, surgery alone in 13%, surgery followed by medical therapy in 9%, and 52% received no treatment. Ten percent responded to surgery alone, 20% responded to additional medical treatment after surgery, and 38% responded to medical therapy alone. Tamoxifen in combination with prednisone was used in 20 patients, and 60% improved. Non-tamoxifen-based regimens were used in 12 patients, and 8% improved. Eighteen deaths were noted during the study period, and 17% were attributed to complications of sclerosing mesenteritis or its treatment. CONCLUSIONS Although a relatively benign condition, sclerosing mesenteritis can have a prolonged debilitating course with a fatal outcome. Our results suggest that symptomatic patients might benefit from medical therapy, particularly tamoxifen and prednisone combination treatment. Long-term follow-up is needed to substantiate these results.
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Affiliation(s)
- Salma Akram
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Katsanos KH, Ioachim E, Michail M, Price AC, Agnantis N, Kappas A, Tsianos EV. A fatal case of sclerosing mesenteritis. Dig Liver Dis 2004; 36:153-6. [PMID: 15002825 DOI: 10.1016/j.dld.2003.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 22-year-old patient was admitted because of abdominal pain and vomiting. Computed tomography diagnosed small intestinal malignancy. Ileal resection was performed, and the histological findings were consistent with sclerosing mesenteritis. The patient was treated with enteral nutrition, corticosteroids, azathioprine and methotrexate, but died 2 years later.
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Affiliation(s)
- K H Katsanos
- Department of Internal Medicine (Hepato-Gastroenterology Unit), Medical School of Ioannina, Leoforos Panepistimiou, 451 10 Ioannina, Greece
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Knoefel WT, Prenzel KL, Peiper M, Hosch SB, Gundlach M, Eisenberger CF, Strate T, Scheunemann P, Rogiers X, Izbicki JR. Klatskin tumors and Klatskin mimicking lesions of the biliary tree. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2003; 29:658-61. [PMID: 14511613 DOI: 10.1016/s0748-7983(03)00148-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM We report on the preoperative capability of imaging modalities and clinical assessment to differentiate between Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Adenocarcinomas of the hepatic ducts (Klatskin tumors) mimic benign fibrosing cholangitis. Extensive resections carry a substantial risk but offer the only chance for cure in patients with a Klatskin tumor. METHODS Thirty-three consecutive patients who underwent resection for suspicion of a malignant tumor of the hepatic hilum were reviewed. All patients underwent preoperative ultrasonography, computed tomography, ERCP and angiography. The patients were divided into a group of true Klatskin tumors and a group of benign Klatskin mimicking lesions. RESULTS Twenty-seven of the resected specimens were malignant tumors, and six lesions showed only fibrosing cholangitis. Preoperative clinical presentation and imaging modalities were very similar between Klatskin tumors and fibrosing cholangitis. CONCLUSIONS Management of obstruction of the liver hilum is dictated by the suspicion of malignancy. Complete removal of the tumor remains the therapeutic aim but clinical presentation and imaging modalities cannot help to differentiate between Klatskin tumors and Klatskin mimicking lesions prior to surgery.
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Affiliation(s)
- W T Knoefel
- Department of Surgery, University of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany.
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