51
|
Wang J, Eng OS, Micic D. Getting to the Root of the Problem. Gastroenterology 2020; 158:1229-1231. [PMID: 31560904 DOI: 10.1053/j.gastro.2019.08.055] [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: 07/25/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Jennifer Wang
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Oliver S Eng
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, Illinois
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois.
| |
Collapse
|
52
|
Bansal P, Gilbert EL, Pereira ROL, Virata AR. Mesenteric panniculitis in a patient with new onset dermatomyositis. BMJ Case Rep 2020; 13:13/1/e232183. [PMID: 32014990 DOI: 10.1136/bcr-2019-232183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mesenteric panniculitis (MP), part of the spectrum of sclerosing mesenteritis, is an often asymptomatic disorder that is characterised by chronic inflammation of abdominal mesentery. We present a case of an 83-year-old woman who presented with proximal muscle weakness and erythematous, photosensitive rash of the face and upper torso and was subsequently diagnosed with dermatomyositis based on skin biopsy, electromyography and muscle biopsy. She had radiographic evidence of panniculitis on CT scan of the abdomen and pelvis for malignancy surveillance, which improved on serial CT scan 3 months after beginning treatment for her underlying dermatomyositis with prednisone and mycophenolate mofetil. Our case highlights that MP can be associated with underlying autoimmune disease. Connective tissue disease could be considered in the differential of MP when other etiologies such as surgery, trauma and malignancy are ruled out.
Collapse
Affiliation(s)
- Pankaj Bansal
- Rheumatology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Emily L Gilbert
- Internal Medicine, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | | | - Andrew R Virata
- Pathology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| |
Collapse
|
53
|
Dahiya DS, Kichloo A, Singh J, Albosta MS, Wani F, Aljadah M, Haq KF. Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review. J Investig Med High Impact Case Rep 2020; 8:2324709620969581. [PMID: 33138661 PMCID: PMC7649945 DOI: 10.1177/2324709620969581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare, benign, and idiopathic disorder characterized by chronic inflammation of the mesenteric adipose tissue of the small intestine. The exact etiology of MP is unknown and its associations with underlying malignancies continues to be poorly understood. In this case report, we describe a rare case of acute exacerbations of MP in a middle-age female with a known past medical history of non-Hodgkin’s lymphoma in remission and small bowel resection for a localized carcinoid tumor. The patient was diagnosed with MP 4 years ago and started on tamoxifen therapy with adequate control of her symptoms. Last year, she reported to the emergency department with multiple episodes of sudden-onset, severe, and localized right upper quadrant abdominal pain and nausea without vomiting. She was diagnosed with an acute exacerbation of MP and a decision was made to add 60 mg prednisone daily in addition to her tamoxifen regimen. She remained symptomatically stable for the next 6 months after the start of dual therapy with tamoxifen and prednisone. However, for the past 6 months, the patient reported to the emergency department on an average of 2 times/month with the same recurrent symptoms despite high compliance with tamoxifen and prednisone therapy. She was admitted for her pain management and her dose of prednisone was increased and she was subsequently discharged home with improvement of her symptoms. Her tamoxifen was switched to mycophenolate on her follow-up visit with gastrointestinal clinic, and her disease has remained stable for the past 2 months. Our case report discusses in-depth the literature on MP and its management. We also detail the steps in management of a rare case of recurrent acute exacerbations of MP despite the patient being on immunosuppressive therapy.
Collapse
Affiliation(s)
| | | | | | | | - Farah Wani
- Central Michigan University, Saginaw, MI, USA
| | | | | |
Collapse
|
54
|
Buragina G, Magenta Biasina A, Carrafiello G. Clinical and radiological features of mesenteric panniculitis: a critical overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:411-422. [PMID: 31910164 PMCID: PMC7233778 DOI: 10.23750/abm.v90i4.7696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
The mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the mesenteric panniculitis with only the inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, there are two main signs: the fat ring sign, which is the presence of normal fat around vessels and lymph nodes, and the pseudocapsula around the lesion. In this paper, we present the imaging and clinical features of mesenteric panniculits with particular reference to the differential diagnosis and the possible etiological associations. (www.actabiomedica.it)
Collapse
|
55
|
Baxi AC, Swanson PE, Tomizawa Y. An Unusual Cause of Abdominal Pain. Gastroenterology 2019; 157:1490-1491. [PMID: 30981789 DOI: 10.1053/j.gastro.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Anand C Baxi
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Paul E Swanson
- Department of Pathology, University of Washington, Seattle, Washington
| | - Yutaka Tomizawa
- Division of Gastroenterology, University of Washington, Seattle, Washington
| |
Collapse
|
56
|
Meyyur Aravamudan V, Khan SR, Natarajan SK, Hussain I. The Complex Relationship between Mesenteric Panniculitis and Malignancy - A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties. Cureus 2019; 11:e5569. [PMID: 31695988 PMCID: PMC6820662 DOI: 10.7759/cureus.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mesenteric panniculitis is an idiopathic, localized inflammation involving the adipose tissue of the small bowel mesentery. The association of mesenteric panniculitis with malignancy, predominantly lymphomas, has been widely reported in the medical literature. In this review article, we will discuss the clinical guidelines in the diagnosis and management of mesenteric panniculitis and the clinical association between mesenteric panniculitis and malignancies.
Collapse
Affiliation(s)
| | - Shahab R Khan
- Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, USA
| | | | - Ikram Hussain
- Internal Medicine: Gastroenterology, Woodlands Health Campus, Singapore, SGP
| |
Collapse
|
57
|
Demystifying the mesenteric root lesions. Abdom Radiol (NY) 2019; 44:2708-2720. [PMID: 31079195 DOI: 10.1007/s00261-019-02053-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this article is to describe the normal anatomy of the root of the small bowel mesentery (RSBM) as well as the multidetector computed tomography (MDCT) features of the various primary and secondary lesions that affect the RSBM. RESULTS The small bowel mesentery attaches the jejunum and ileum to the posterior abdominal wall, the line of attachment forming the RSBM. Several primary as well as secondary lesions involve the RSBM. The RSBM has anatomical contiguity with the mesocolon and other peritoneal ligaments, which forms a route for the spread of infection, neoplasms as well as several other abdominal pathologies. MDCT plays an important role in the evaluation of mesenteric root lesions. CONCLUSION Familiarity with the lesions involving the RSBM and their characteristic appearances on MDCT is important in giving thoughtful differential diagnosis and guiding the treating physician in further management.
Collapse
|
58
|
Tibana TK, Santos RFT, Camilo DMR, Marchiori E, Nunes TF. Mesenteric panniculitis in a patient with rheumatoid arthritis. Radiol Bras 2019; 52:277-278. [PMID: 31435096 PMCID: PMC6696752 DOI: 10.1590/0100-3984.2017.0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tiago Kojun Tibana
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
59
|
Abstract
BACKGROUND Sclerosing mesenteritis (SM) and mesenteric panniculitis are rare processes of the mesentery which pose a major clinical and imaging challenge. This review article attempts to introduce a systematic nomenclature to address typical symptoms, imaging and major differential diagnoses. RESULTS SM with its subtypes-mesenteric lipodystrophy, panniculitis and retractile mesenteritis-is a chronic process with a very diverse and heterogeneous clinical appearance. The typical radiological characteristics ("misty mesentery", increased lymph nodes, pseudocapsule and "fat halo") are also not very specific. A link between SM and malignant diseases is not proven, but there is controversial discussion. Therefore, if there are doubts about the diagnosis, further examinations and a biopsy are desired. CONCLUSION When diagnosing SM, "red flags", i. e. characteristics that are atypical for SM in imaging, should be considered. In case of ambiguous imaging, differential diagnostics should also consider malignant diseases and exclude them.
Collapse
|
60
|
Patel A, Alkawaleet Y, Young M, Reddy C. Mesenteric Panniculitis: An Unusual Presentation of Abdominal Pain. Cureus 2019; 11:e5100. [PMID: 31428545 PMCID: PMC6693797 DOI: 10.7759/cureus.5100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sclerosing mesenteritis is a rare autoimmune disease that eventually evolves into fibrotic changes that usually affect the adipose tissue around the mesenteric vessels. It can present through a myriad of gastroenterological as well as constitutional symptoms, including but not limited to abdominal pain, diarrhea, fever, nausea, or vomiting. Although the exact etiology of the disease is yet to be determined, there are several predisposing factors, the most common of which is a previous history of abdominal trauma and/or surgery. Several case series have reported the association of sclerosing mesenteritis with prior abdominal surgery ranging from as low as 24% to as high as 53%.
Collapse
Affiliation(s)
- Ankit Patel
- Miscellaneous, Quillen College of Medicine, East Tennessee State University, Johnson CIty, USA
| | - Yazan Alkawaleet
- Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Mark Young
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Chakradhar Reddy
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| |
Collapse
|
61
|
Abstract
Sclerosing mesenteritis is a rare benign disease presenting with chronic inflammation of the mesenteric adipose tissue and variable degrees of fibrosis. A 47-year-old black man presented to the emergency department with symptoms of small bowel obstruction, requiring surgical treatment. The laparotomy revealed a stenosis of the distal ileum with mesenteric thickening and an enterectomy was performed. The postoperative period was complicated by the maintenance of bowel obstruction. The patient underwent a second laparotomy, in which the fibrosing process of the mesentery was much aggravated, and an ileo-colic resection was needed. After knowledge of the histological diagnosis, the patient was started on immunomodulators with clinical improvement. At 26 months of follow-up, patient is asymptomatic under medical treatment. This is the first report, to our knowledge, of a patient with progressive fibrosis in such short period of time requiring surgical re-intervention for bowel obstruction, owing to sclerosing mesenteritis.
Collapse
Affiliation(s)
- Sofia Costa Corado
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Heitor Almeida
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | |
Collapse
|
62
|
Vashi B, Khosroshahi A. IgG4-Related Disease with Emphasis on Its Gastrointestinal Manifestation. Gastroenterol Clin North Am 2019; 48:291-305. [PMID: 31046976 DOI: 10.1016/j.gtc.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IgG4-related disease is an immune-mediated fibroinflammatory condition with a diverse spectrum of organ involvement, commonly in the pancreas and bile ducts among other organs such as salivary and lacrimal glands. Classic histopathologic findings are the gold standard for confirmation of diagnosis, although diagnosis remains challenging, as biomarkers to date are neither sufficient nor necessary. Glucocorticoids are the most effective initial treatment, generally having a dramatic response, although limited clinical evidence exists regarding effective maintenance therapy. This review summarizes key GI manifestations of this condition for the practicing gastroenterologist and addresses the pathology, disease mechanism, and current therapeutic recommendations.
Collapse
Affiliation(s)
- Bijal Vashi
- Department of Medicine, Emory University, 200 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA
| | - Arezou Khosroshahi
- Department of Medicine, Emory University, 244 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA.
| |
Collapse
|
63
|
Abstract
Sclerosing mesenteritis is a rare non-neoplastic disorder characterized by fat necrosis, chronic inflammation, and fibrosis typically of the small bowel mesentery. Our understanding of this disorder is limited by its rarity as well as inconsistent terminology used across the literature. While prior abdominal surgery or trauma, autoimmunity, infection, ischemia, and malignancy have been suggested to be involved in the pathogenesis of the disorder, it remains poorly understood. The clinical course of sclerosing mesenteritis is generally benign with a large proportion of patients diagnosed incidentally on imaging obtained for other indications. In a subset of patients, symptoms may arise from a mass effect on the bowel, lymphatics, or vasculature resulting in bowel obstruction, chylous ascites, or mesenteric ischemia. Symptomatic patients should be treated with a combination of corticosteroid and tamoxifen as first-line therapy based on retrospective case series and experience in other fibrosing disorders. Surgical intervention may be required in those with persistent obstruction despite conservative treatment, though complete resection of the mass is often not feasible given intimate involvement with the mesenteric vasculature. A careful use of terminology and communication between the radiologist, pathologist, and clinicians in the care of these patients will be essential to future efforts at understanding this disease.
Collapse
|
64
|
Zhao ME, Zhang LQ, Ren L, Li ZW, Xu XL, Wang HJ, Wang ZX, Li HL, Bao YY, Fan HN, Yangdan CR. A case report of mesenteric panniculitis. J Int Med Res 2019; 47:3354-3359. [PMID: 31122101 PMCID: PMC6683908 DOI: 10.1177/0300060519845785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 65-year-old man had intermittent abdominal pain for the previous 2 years. This pain suddenly became worse with a fever and elevated inflammatory markers. We took a while to diagnose the patient with mesenteric panniculitis (MP). Although imaging findings suggested MP, we needed to rule out other diseases. Choosing a treatment for the patient also took some time and we finally used glucocorticoid to cure the patient.
Collapse
Affiliation(s)
- Ming-En Zhao
- 1 Medical College of Qinghai University, Xining, China.,2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Ling-Qiang Zhang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Li Ren
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhen-Wei Li
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Xiao-Lei Xu
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Jiu Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhi-Xin Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Long Li
- 4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Yuan-Yuan Bao
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Ning Fan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,3 Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
| | - Cai-Rang Yangdan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| |
Collapse
|
65
|
Abstract
Abdominal pain is a common reason for referral to a gastroenterologist. The workup of patients with chronic abdominal pain can be extremely challenging as clinicians are responsible for determining whether the patient can be observed or treated symptomatically or this abdominal pain heralds a more systemic disease. The differential is typically wide and given the innervation of the abdomen, localization of abdominal pain does not always provide clear insight into the etiology. This review attempts to help the gastroenterologist narrow down that broad differential and focus on key elements of the patient visit. We emphasize the importance of a detailed history from the patient, along with review-specific details of their history and physical examination that can clue one in about the etiology of the abdominal pain. We review the causes of diffuse abdominal pain that may not first be considered along with uncommon causes of localized abdominal pain. We also review the functional causes of abdominal pain and the importance of identifying these disorders, to avoid unnecessary testing that commonly occurs with these patients.
Collapse
|
66
|
Turcotte B, Toren P, Cloutier J. Images - Sclerosing mesenteritis presenting with unilateral hydro-ureteronephrosis. Can Urol Assoc J 2019; 13:E306-E308. [PMID: 30763232 DOI: 10.5489/cuaj.5689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
| |
Collapse
|
67
|
Soriano Rios A, Paredes H, Hernández-Calleros J, Uscanga-Domínguez L, Peláez-Luna M. Retroperitoneal fibrosis. Steroid treatment response seems to depend on its association to IgG4 related disease. Med Hypotheses 2019; 122:120-123. [DOI: 10.1016/j.mehy.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/06/2018] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
|
68
|
G K A, Jindal SP, Madaan V, Gupta R, Tandon V, Govil D. Malignant masquerade sclerosing mesenteritis: A case report and review. Int J Surg Case Rep 2018; 53:265-268. [PMID: 30567051 PMCID: PMC6263015 DOI: 10.1016/j.ijscr.2018.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/18/2018] [Accepted: 10/13/2018] [Indexed: 10/29/2022] Open
Abstract
Mesenteric panniculitis (MP), also known as sclerosing mesenteritis (SM), retractile mesenteritis or mesenteric lipodystrophy, is a rarely diagnosed inflammatory condition of unknown etiology that involves the mesenteric adipose tissue. We are presenting a case of sclerosing mesenteritis which presented us with features suggestive of malignant lesion and turned out to be benign one. An elderly gentleman of 68 years male presented to us with history of nonprogressive pain abdomen since 2 months associated with low grade fever and on and off constipation. On evaluation with CECT he was found to have mesenteric mass probably malignant. PET/CT showed an FDG avid lesion suggestive of malignancy, requiring surgery. He underwent radical excision of mesentery with resection of corresponding bowel. Final histopathology report showed poorly defined lesion comprised of nodular, poorly defined proliferation of bland looking fibroblast like cells, which at places are lying in fascicles, in a background of dense fibrosis and mature fat cells, with prominent focal lymphocytic infiltrate, at place forming reactive follicles, suggestive of sclerosing mesenteritis. Now patient is on follow up for further therapy.
Collapse
|
69
|
Tamoxifen attenuates dialysate-induced peritoneal fibrosis by inhibiting GSK-3β/β-catenin axis activation. Biosci Rep 2018; 38:BSR20180240. [PMID: 30061174 PMCID: PMC6246765 DOI: 10.1042/bsr20180240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/04/2018] [Accepted: 07/26/2018] [Indexed: 12/29/2022] Open
Abstract
Peritoneal fibrosis is a severe complication arising from long-term peritoneal dialysis (PD). Tamoxifen (Tamo) has been clinically proven effective in a series of fibrotic diseases, such as PD-associated encapsulating peritoneal sclerosis (EPS), but the mechanisms underlying Tamoxifen’s protective effects are yet to be defined. In the present study, C57BL/6 mice received intraperitoneal injections of either saline, 4.25% high glucose (HG) PD fluid (PDF) or PDF plus Tamoxifen each day for 30 days. Tamoxifen attenuated thickening of the peritoneum, and reversed PDF-induced peritoneal expression of E-cadherin, Vimentin, matrix metalloproteinase 9 (MMP9), Snail, and β-catenin. Mouse peritoneal mesothelial cells (mPMCs) were cultured in 4.25% glucose or 4.25% glucose plus Tamoxifen for 48 h. Tamoxifen inhibited epithelial-to-mesenchymal transition (EMT) as well as phosphorylation of glycogen synthase kinase-3β (GSK-3β), nuclear β-catenin, and Snail induced by exposure to HG. TWS119 reversed the effects of Tamoxifen on β-catenin and Snail expression. In conclusion, Tamoxifen significantly attenuated EMT during peritoneal epithelial fibrosis, in part by inhibiting GSK-3β/β-catenin activation.
Collapse
|
70
|
Green MS, Chhabra R, Goyal H. Sclerosing mesenteritis: a comprehensive clinical review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:336. [PMID: 30306075 DOI: 10.21037/atm.2018.07.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sclerosing mesenteritis is a rare disease entity initially described in 1924 with a prevalence reported to be less than 1%. Sclerosing mesenteritis is a comprehensive term used to describe three almost similar clinical entities including mesenteric panniculitis, retractile mesenteritis, and mesenteric lipodystrophy which only differ by their histology. The etiology of sclerosing mesenteritis is uncertain, but the disease has been associated with trauma, autoimmune disease, surgery, and malignancy. The typical presenting symptom is the abdominal pain, but sclerosing mesenteritis has a broad constellation of presenting symptoms which often makes consideration of the diagnosis unlikely. Treatment for this little-understood disease ranges from surgical intervention for patients presenting with obstructive symptoms to immunosuppressive medical therapy for patients presenting with pain. The purpose of this article is to provide an overview of the literature relevant to the diagnosis, etiology, and management of this condition in hopes of making physicians aware of this unique condition.
Collapse
Affiliation(s)
- Michael S Green
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| |
Collapse
|
71
|
|
72
|
Kaya C, Bozkurt E, Yazıcı P, İdiz UO, Tanal M, Mihmanlı M. Approach to the diagnosis and treatment of mesenteric panniculitis from the surgical point of view. Turk J Surg 2018; 34:121-124. [PMID: 30023976 DOI: 10.5152/turkjsurg.2018.3881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/05/2017] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the diagnostic and treatment approaches for patients diagnosed with mesenteric panniculitis. Material and Methods We retrospectively reviewed all patients diagnosed with mesenteric panniculitis between January 2010 and March 2016. We recorded the demographic features, clinical symptoms, laboratory values, radiological methods, treatment approach, and outcomes of the patients. Results We evaluated 22 patients (17 male and five female) with a mean age of 45.8±15.7 years. The most frequent complaint was abdominal pain. The patients' histories included colon cancer (n=1), prostatic cancer (n=2), renal cell cancer (n=1), diabetes mellitus (n=4), and chronic obstructive pulmonary disease (n=1). Laboratory values revealed elevated C-reactive protein levels in 14 patients (43%). Computed tomography was performed in all the patients. Only 10 patients were followed up in the surgical ward, the remaining 12 underwent outpatient treatment. No complication associated with hospitalization or during outpatient follow-up period was observed. Conclusion Mesenteric panniculitis can be successfully treated conservatively without surgical intervention. Clinical doubt is of great importance for diagnosis, and plausible underlying malignancy should be kept in mind.
Collapse
Affiliation(s)
- Cemal Kaya
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Emre Bozkurt
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ufuk Oğuz İdiz
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mert Tanal
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Mihmanlı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
73
|
Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kai-Sheng Liao
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chih-Jen Huang
- Department of General Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| |
Collapse
|
74
|
Mahafza WS, Manzalawi KA, Gharaibeh AA, Khayat OW, Shahait A, Juweid ME. Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history. Saudi Med J 2018; 38:1013-1018. [PMID: 28917065 PMCID: PMC5694634 DOI: 10.15537/smj.2017.10.20163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). METHODS This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. RESULTS Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.
Collapse
Affiliation(s)
- Waleed S Mahafza
- Diagnostic Radiology Department, The Jordan University Hospital, Amman, Jordan. E-mail.
| | | | | | | | | | | |
Collapse
|
75
|
|
76
|
Williams DS. Mesenteric Panniculitis. J Insur Med 2018; 47:130-132. [PMID: 29490158 DOI: 10.17849/insm-47-02-130-132.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mesenteric panniculitis is a rare, benign, and chronic fibrosing inflammatory disease that affects the adipose tissue of the small intestine and colon.
Collapse
|
77
|
|
78
|
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.
Collapse
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
| |
Collapse
|
79
|
Shagufta, Ahmad I. Tamoxifen a pioneering drug: An update on the therapeutic potential of tamoxifen derivatives. Eur J Med Chem 2018; 143:515-531. [DOI: 10.1016/j.ejmech.2017.11.056] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
|
80
|
Mizuno S, Wakui M, Machida Y, Hosoe N, Hisamatsu T, Ishida T, Kameyama K, Naganuma M, Kanai T. Increased levels of prostaglandin E-major urinary metabolite (PGE-MUM) in active mesenteric panniculitis patients: A case report. Medicine (Baltimore) 2017; 96:e9237. [PMID: 29390478 PMCID: PMC5758180 DOI: 10.1097/md.0000000000009237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mesenteric panniculitis (MP) is a rare disease with abdominal and systemic symptoms and is characterized by nonspecific inflammation, fat necrosis, and fibrosis in mesenteric fat. Active inflammatory responses may increase levels of prostaglandin E-major urinary metabolite (PGE-MUM), which was reported to reflect the disease activity of ulcerative colitis and chronic fibrosing interstitial pneumonia. We recently experienced a case with elevated PGE-MUM at the time of diagnosis of MP and we investigated the potential of PGE-MUM as a biomarker. PATIENT CONCERN In this report we described 2 active mesenteric panniculitis patients with high PGE-MUM levels. DIAGNOSES Mesenteric panniculitis INTERVENTIONS:: Both MP patients were measured the levels of PGE-MUM. OUTCOMES Both MP patients exhibited high levels of PGE-MUM before treatment. In one, the levels were sensitively correlated with clinical symptoms and serological markers on steroids. LESSONS The study observations suggest the potential of PGE-MUM to reflect the disease activity of MP. To verify its use, more findings based on clinical studies should be accumulated.
Collapse
Affiliation(s)
- Shinta Mizuno
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | | | - Yujiro Machida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy
| | - Tadakazu Hisamatsu
- The Third Department of Internal Medicine, Kyorin University School of Medicine
| | | | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| |
Collapse
|
81
|
Ueno M, Nishimura N, Shimodate Y, Doi A, Mouri H, Matsueda K, Yamamoto H, Mizuno M. Sclerosing mesenteritis diagnosed with computed tomography and ultrasound-guided needle biopsy: the utility of the coaxial technique. Clin J Gastroenterol 2017; 11:92-95. [PMID: 29143914 DOI: 10.1007/s12328-017-0800-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
Here we report a case of sclerosing mesenteritis that we diagnosed with needle biopsy under the guidance of computed tomography (CT) and ultrasound (US) observation. An 82-year-old woman presented with appetite loss, weight loss and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel and enlarged lymph nodes. Sclerosing mesenteritis was suspected, but malignancies, such as lymphoma, were also considered. We performed CT and US-guided needle biopsy with the coaxial technique. An introducer needle was inserted, its correct location was documented with CT, and multiple specimens were taken with a finer needle passed through the introducer without incident. Adequate specimens were obtained, and the histological diagnosis of sclerosing mesenteritis was made. We treated the patient with corticosteroids and her symptoms and the radiographic findings improved. The coaxial technique was a useful and minimally invasive tool for making the diagnosis of sclerosing mesenteritis.
Collapse
Affiliation(s)
- Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| |
Collapse
|
82
|
Sclerosing mesenteritis as a presentation of myelodysplastic syndrome (MDS) with improvement following treatment targeted at MDS. Ann Hematol 2017; 97:547-549. [PMID: 29134269 DOI: 10.1007/s00277-017-3177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
|
83
|
Liang CP, Yang M, Chen PY, Geng LL, Li DY, Gong ST. Sclerosing mesenteritis in a 5-year-old Chinese boy: a case report. BMC Pediatr 2017; 17:179. [PMID: 28764764 PMCID: PMC5540191 DOI: 10.1186/s12887-017-0931-8] [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: 08/26/2015] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
Background Sclerosing mesenteritis is a rare fibroinflammatory disorder of unknown etiology that primarily affects the mesentery of the small intestine during late adult life. Only about twenty pediatric cases have been reported to date, but none has been reported in Chinese children. Case presentation A 5-year-old Chinese male presented with a 4-week history of recurrent bloating, abdominal pain, anorexia and vomiting. On admission, physical examination showed a severely distended abdomen. Biochemical investigations showed a slightly increased C-reactive protein, and normal serum levels of electrolytes and erythrocyte sedimentation rate. An abdominal film showed small intestine obstruction and massive ascites. An exploratory laparotomy revealed widespread inflammatory fibrotic adhesions between the bowel and the abdominal wall, thickening of the small bowel and massive ascites. During a prolonged hospital course, a 2nd surgery (4 months after 1st exploratory laparotomy) was performed in order to close the ileostomy and revealed that the bowel was still severely edematous, with very tight adhesions between the bowel and the abdominal wall. Histopathological examination of excised mesentery and nodules showed chronic inflammatory cell infiltration, fat necrosis and fibrosis. A diagnosis of sclerosing mesenteritis was finally established. Prednisolone at 2 mg/kg was started and he experienced rapid clinical improvement in 4 weeks. Conclusions Sclerosing mesenteritis is extremely rare in children and often misdiagnosed due to its nonspecific clinical manifestation. It is important to be aware of sclerosing mesenteritis when evaluating a child with intractable abdominal pain, bloating, intestinal obstruction and massive ascites.
Collapse
Affiliation(s)
- Cui-Ping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Min Yang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Pei-Yu Chen
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Lan-Lan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Ding-You Li
- Department of Pediatrics, Division of Gastroenterology, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Si-Tang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China.
| |
Collapse
|
84
|
Watanabe T, Terai S, Tsukada T, Takeshita M, Matsui K, Amaya K, Kaji M, Maeda K, Shimizu K, Saito J, Mochizuki K, Uchiyama A. Sclerosing mesenteritis mimicking metachronous peritoneal metastases from descending colon adenocarcinoma. World J Surg Oncol 2017; 15:142. [PMID: 28764712 PMCID: PMC5540343 DOI: 10.1186/s12957-017-1214-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Sclerosing mesenteritis is a non-neoplastic inflammatory disease that occurs in the bowel mesentery. Distinguishing sclerosing mesenteritis from neoplasms may be difficult because of the clinical and radiographic similarities between the two disease entities. Case presentation We report a case of sclerosing mesenteritis mimicking peritoneal metastases of colorectal carcinoma. A 73-year-old man with stage II descending colon adenocarcinoma with poor prognostic features was found to have developed left lower abdominal quadrant masses on computed tomography (CT) 9 months after undergoing radical surgery. These masses were diagnosed as peritoneal metastases because they grew in size and displayed fluorodeoxyglucose (FDG) uptake 3 months later; thus, a laparotomy was performed. The masses, which were localized in the jejunal mesentery, were excised completely via segmental jejunal resection. Histopathological analysis confirmed that the masses were sclerosing mesenteritis. The patient showed no signs of sclerosing mesenteritis or colorectal carcinoma recurrence during follow-up. Conclusions In patients suspected of having localized peritoneal metastasis from malignancies, any masses must be sampled by surgical excisional biopsy and subsequently examined to rule out alternative diagnoses, such as sclerosing mesenteritis.
Collapse
Affiliation(s)
- Toshifumi Watanabe
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan.
| | - Shiro Terai
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masaki Takeshita
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koshi Matsui
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koji Amaya
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kiichi Maeda
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Junko Saito
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kentaro Mochizuki
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Akio Uchiyama
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| |
Collapse
|
85
|
Gomes DC, Quaresma L. Sclerosing mesenteritis: a benign cause of mesenteric mass lesions. Pan Afr Med J 2017; 27:228. [PMID: 28979630 PMCID: PMC5622839 DOI: 10.11604/pamj.2017.27.228.11542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/01/2017] [Indexed: 01/07/2023] Open
Abstract
Sclerosing mesenteritis is a rare disease of the mesentery. Associations with surgery, trauma, autoimmunity and paraneoplastic syndrome have been suggested, but most of the cases remain idiopathic. Diagnosis is often incidental, based upon the finding of a single or multiple mesenteric lesions on abdominal CT and histopathological confirmation. Optimal treatment is still controversial, but most of the cases reported have a favourable prognosis. We present a case of a 54-year-old male with long-standing abdominal pain and nausea, whose CT revealed the presence of a large mesenteric mass. A biopsy was performed, revealing benign chronic inflammation, fibrosis and IgG4-positive plasmocytes consistent with sclerosing mesenteritis. Clinical remission was achieved with corticosteroids and follow-up CTs at six and twelve months documented stability of the lesion. Furthermore, we review the current literature on the diagnosis and treatment options for this rare disease.
Collapse
Affiliation(s)
| | - Luísa Quaresma
- Surgery Service, Hospital Center Lisboa Central, Lisboa, Portugal
| |
Collapse
|
86
|
Saito Y, Hiramatsu K, Nosaka T, Ozaki Y, Takahashi K, Naito T, Ofuji K, Matsuda H, Ohtani M, Nemoto T, Imamura Y, Nakamoto Y. A case of protein-losing enteropathy caused by sclerosing mesenteritis diagnosed with capsule endoscopy and double-balloon endoscopy. Clin J Gastroenterol 2017; 10:351-356. [PMID: 28664384 DOI: 10.1007/s12328-017-0755-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
A 75-year-old man presented with abdominal distension, hypoproteinemia, ascites and a 35-mm mass in the small bowel mesentery. Laparotomy was performed, and he was diagnosed with sclerosing mesenteritis. His clinical condition improved, with computed tomography (CT) showing tumor shrinkage and decreasing ascites after administration of prednisolone; however, on drug withdrawal, abdominal fullness recurred and CT revealed an enlarging tumor and increasing ascites. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) were performed to further investigate hypoalbuminemia, which revealed white villi, white nodules, white debris, and mucosal edema in the jejunum. Biopsies from the jejunal mucosa demonstrated infiltration by chronic inflammatory cells consisting mostly of lymphocytes and plasma cells, with marked lymphangiectasia of the lamina propria and submucosa. A fecal alpha-1-antitrypsin clearance test revealed abnormal leakage from the gastrointestinal tract, confirming that hypoalbuminemia was secondary to protein-losing enteropathy (PLE). The incidence of sclerosing mesenteritis accompanied by PLE is very rare. Only six cases have been reported so far. CE and DBE were helpful for diagnosing this condition, and should be performed in patients in whom the cause of hypoalbuminemia is unknown, and in those with PLE.
Collapse
Affiliation(s)
- Yasushi Saito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Katsushi Hiramatsu
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Takuto Nosaka
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yoshihiko Ozaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuto Takahashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuya Ofuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hidetaka Matsuda
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Masahiro Ohtani
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tomoyuki Nemoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yoshiaki Imamura
- Department of Pathology, University of Fukui Hospital, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| |
Collapse
|
87
|
Lim HW, Sultan KS. Sclerosing Mesenteritis Causing Chylous Ascites and Small Bowel Perforation. AMERICAN JOURNAL OF CASE REPORTS 2017. [PMID: 28638005 PMCID: PMC5490507 DOI: 10.12659/ajcr.904382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient: Male, 80 Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal distension • abdominal tenderness Medication: — Clinical Procedure: Paracentesis Specialty: Gastroenterology and Hepatology
Collapse
Affiliation(s)
- Huei-Wen Lim
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Keith S Sultan
- Department of Gastroenterology and Hepatology, Northwell Health, Manhasset, NY, USA
| |
Collapse
|
88
|
Nyberg L, Björk J, Björkdahl P, Ekberg O, Sjöberg K, Vigren L. Sclerosing mesenteritis and mesenteric panniculitis - clinical experience and radiological features. BMC Gastroenterol 2017; 17:75. [PMID: 28610559 PMCID: PMC5470176 DOI: 10.1186/s12876-017-0632-7] [Citation(s) in RCA: 19] [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] [Received: 03/22/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory conditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical SM is not fully understood. The aims of this study were to determine whether any correlation could be found between the radiological findings and the clinical disease course. METHODS Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be verified histologically or MP radiologically, the patients were included in this descriptive retro perspective study. RESULTS Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to moderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to histologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All four had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with multiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM. CONCLUSIONS We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic changes and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the term SM should be reserved for this latter condition.
Collapse
Affiliation(s)
- Lisa Nyberg
- Department of Medicine, Division of Gastroenterology, Hospital of Trelleborg, Trelleborg, Sweden.
| | - Jan Björk
- Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Björkdahl
- Department of Radiology, Division of Surgery, Ystad Hospital, Ystad, Sweden
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Klas Sjöberg
- Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lina Vigren
- Department of Medicine, Division of Gastroenterology, Hospital of Trelleborg, Trelleborg, Sweden
| |
Collapse
|
89
|
Sclerosing mesenteritis: a systematic review of 192 cases. Clin J Gastroenterol 2017; 10:103-111. [DOI: 10.1007/s12328-017-0716-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/26/2017] [Indexed: 02/06/2023]
|
90
|
Sahin A, Artas H, Eroglu Y, Tunc N, Demirel U, Bahcecioglu IH, Yalniz M. An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis. Med Princ Pract 2017; 26:567-572. [PMID: 29073610 PMCID: PMC5848480 DOI: 10.1159/000484605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/26/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. SUBJECTS AND METHODS This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathic and secondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. RESULTS Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. CONCLUSION In this study, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.
Collapse
Affiliation(s)
- Abdurrahman Sahin
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
- *Abdurrahman Sahin, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Yunus Emre Avenue 20, TR-23119 Elazig (Turkey), E-Mail
| | - Hakan Artas
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Yesim Eroglu
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Nurettin Tunc
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Ulvi Demirel
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | | | - Mehmet Yalniz
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| |
Collapse
|
91
|
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.
Collapse
Affiliation(s)
- William Makis
- From the Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, Alberta, Canada
| |
Collapse
|
92
|
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: 1.1] [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.
Collapse
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
| |
Collapse
|
93
|
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: 2.8] [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.
Collapse
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
| |
Collapse
|
94
|
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: 171] [Impact Index Per Article: 21.4] [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.
Collapse
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
| |
Collapse
|
95
|
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; 41:2031-47. [PMID: 27277528 DOI: 10.1007/s00261-016-0799-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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.
Collapse
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
| |
Collapse
|
96
|
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: 2.0] [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.
Collapse
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
| |
Collapse
|
97
|
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: 0.3] [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.
Collapse
|
98
|
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: 0.4] [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.
Collapse
|
99
|
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: 0.4] [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.
Collapse
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
| |
Collapse
|
100
|
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: 9] [Impact Index Per Article: 1.1] [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.
Collapse
|