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Fukuda M, Miyake T, Matsubara A, Ikai N, Tanaka E, Namura T, Wada Y, Noujima M, Moritani S, Murakami K, Andoh A, Tani M, Kushima R. Sclerosing Mesenteritis Mimicking IgG4-related Disease. Intern Med 2020; 59:513-518. [PMID: 31708540 PMCID: PMC7056383 DOI: 10.2169/internalmedicine.3221-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 72-year-old man was followed as an outpatient at our hospital for 6 years after surgery for small cell carcinoma of left adrenal gland origin. Follow-up abdominal computed tomography showed a 6-cm mass in the left lower mesentery. The patient underwent open laparotomy. The histological diagnosis was sclerosing mesenteritis. The previous specimens of the left adrenal mass were then re-examined with a microscope, and panniculitis was found around the small cell carcinoma. Both lesions were histologically similar to IgG4-related disease (RD), but they did not completely meet the diagnostic criteria of IgG4-RD clinically or histologically.
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Affiliation(s)
- Masahide Fukuda
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Akiko Matsubara
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Nobuyasu Ikai
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Eri Tanaka
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Tomo Namura
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Yasuhiro Wada
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Mai Noujima
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Suzuko Moritani
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Akira Andoh
- Division of Gastrointestinal Endoscopy, Shiga University of Medical Science Hospital, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Ryoji Kushima
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
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Kwon TH, Cho KB, Lee HJ, Kwon SY, Lee YS. [Immunoglobulin G4 Unrelated Idiopathic Mesenteric Sclerosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:50-55. [PMID: 30690959 DOI: 10.4166/kjg.2019.73.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/23/2018] [Accepted: 06/24/2018] [Indexed: 11/03/2022]
Abstract
Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16-3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.
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Affiliation(s)
- Tae Hyung Kwon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Jik Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Suk Lee
- Division of Gastroenterology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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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: 0.9] [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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