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Dadkhah A, Jafari S, Bagheri SM, Ebrahimi A. Association between mesenteric panniculitis and urolithiasis. Emerg Radiol 2024:10.1007/s10140-024-02255-9. [PMID: 38969913 DOI: 10.1007/s10140-024-02255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat. OBJECTIVES This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis. MATERIALS AND METHODS In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation. RESULTS Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis. CONCLUSION Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.
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Affiliation(s)
- Adeleh Dadkhah
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Hazrate Rasoul Akram Hospital, Niyayesh St, Shahrara, Tehran, Iran
| | - Sedigheh Jafari
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Bagheri
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Hasheminejad Kidney Center (HKC), University of Medical Sciences, Tehran, Iran
| | - Azin Ebrahimi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Radiology, Hazrate Rasoul Akram Hospital, Niyayesh St, Shahrara, Tehran, Iran.
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2
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Aparicio-López D, Matute Najarro MS, Duque Mallén MV. [Sclerosing mesenteritis: A rare lesion that simulates a neoplasm]. Med Clin (Barc) 2024; 162:557-558. [PMID: 38378327 DOI: 10.1016/j.medcli.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Daniel Aparicio-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - M Soledad Matute Najarro
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Victoria Duque Mallén
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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3
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Ohno M, Nishida A, Imai T, Tanaka E, Takahashi K, Miyake T, Tani M, Kushima R, Inatomi O. Relapsing sclerosing mesenteritis with multiple strictures of the small intestine. Clin J Gastroenterol 2024:10.1007/s12328-024-01989-w. [PMID: 38811510 DOI: 10.1007/s12328-024-01989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
Sclerosing mesenteritis (SM) is a rare disorder that involves the mesenteric adipose tissue with chronic fibrosing inflammation. Few reports mention the natural history of severe SM cases. Here, we report a severe and relapsing SM case in which a long-term natural history could be followed. The patient had undergone surgery for small bowel stenosis of unknown cause 10 years earlier. He had stopped visiting the hospital at his discretion. He was admitted to the hospital 10 years later due to recurrent symptoms, and a close examination revealed multiple small intestinal strictures; thus, surgery was performed again. The pathological results revealed that the patient had SM, corticosteroid administration dramatically improved his symptoms, and he has maintained remission for a long time.
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Affiliation(s)
- Masashi Ohno
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan.
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan.
| | - Atsushi Nishida
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan
| | - Takayuki Imai
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Eri Tanaka
- Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Kenichiro Takahashi
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
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4
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Saha B, Tome J, Wang XJ. Sclerosing Mesenteritis: A Concise Clinical Review for Clinicians. Mayo Clin Proc 2024; 99:812-820. [PMID: 38702129 DOI: 10.1016/j.mayocp.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/09/2023] [Accepted: 01/11/2024] [Indexed: 05/06/2024]
Abstract
Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation, and fibrosis most commonly of the mesentery of the small intestine. Sclerosing mesenteritis typically presents in the fifth or sixth decade of life, where patients with a history of abdominal surgery and/or autoimmune disease may be at higher risk. While many patients are asymptomatic, clinical features and complications are related to the mass effect resulting from the inflammation and fibrosis involved in the pathogenesis of SM. When present, common signs, symptoms, and complications include abdominal pain, weight loss, diarrhea, palpable abdominal mass on examination, bowel obstruction, chylous ascites, and mesenteric vessel thrombosis. Although SM was historically diagnosed predominantly by biopsy, current practice has shifted away from this to computed tomography imaging of the abdomen, given the invasive nature of biopsy. However, certain conditions, including mesenteric neoplasia (lymphoma, metastatic carcinoid tumor, desmoid tumor, mesenteric carcinomatosis), can mimic SM on imaging, and if clinical suspicion is equivocal, a biopsy may be warranted for definitive diagnosis. Asymptomatic patients do not require treatment. For patients with pronounced symptoms or complicated SM, the combination of tamoxifen 10 mg twice daily and prednisone 40 mg daily is the first-line pharmacotherapy; no randomized controlled trial of this regimen has been performed. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management. Sclerosing mesenteritis has an overall benign course in most cases, but disease progression and fatal outcomes have been reported.
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Affiliation(s)
- Bibek Saha
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - June Tome
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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5
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Carney JM, Roggli VL, Glass CH, Piña-Oviedo S, Pavlisko EN. The over diagnosis of diffuse mesothelioma: An analysis of 311 cases with recommendations for the avoidance of pitfalls. Ann Diagn Pathol 2024; 68:152248. [PMID: 38182448 DOI: 10.1016/j.anndiagpath.2023.152248] [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] [Received: 12/11/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The diagnosis of mesothelioma may be challenging. We investigated a large database of cases in order to determine the frequency with which a diagnosis of mesothelioma was made incorrectly and the most frequent causes of error. DESIGN A database including more than 4000 consultation cases of histologically confirmed mesothelioma was examined to identify cases in which mesothelioma was diagnosed by at least one pathologist when the available information pointed towards a different diagnosis. RESULTS There were 311 cases misdiagnosed as mesothelioma. The most common category was metastatic carcinoma to the pleura or peritoneum (129 cases: 73 lung carcinomas, 15 renal cell carcinomas). The next most common category was primary lung cancer (111 cases: 55 sarcomatoid carcinoma, 56 pseudomesotheliomatous carcinoma). The third most common category was primary malignancies arising from or near the serosal membranes (33 cases). The fourth most common category was fibrous pleurisy (38 cases). The most common errors were failure to consider important radiographic information regarding the gross distribution of tumor, lack of awareness or consideration of another malignancy, overreliance on certain immunohistochemical results, and failure to perform certain diagnostic histochemical, immunohistochemical, or ultrastructural studies. CONCLUSIONS There are a number of diagnostic pitfalls that can lead to the over diagnosis of mesothelioma. Careful attention to clinical and radiographic information as well as performance of appropriate ancillary tests can help to prevent such misdiagnoses. Detailed examples will be presented to assist in the avoidance of these pitfalls with emphasis on the most commonly observed errors.
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Affiliation(s)
- John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sergio Piña-Oviedo
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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6
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Wang H, Zhao Z, Cao Q, Ning J. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China. BMC Gastroenterol 2024; 24:48. [PMID: 38267839 PMCID: PMC10809466 DOI: 10.1186/s12876-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition. PATIENTS AND METHODS Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed. RESULTS There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases. CONCLUSION MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.
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Affiliation(s)
- Hongyan Wang
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Zhenyu Zhao
- Radiology, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Qiucai Cao
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Jing Ning
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China.
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7
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Flor N, Ferretti F, Pellegrinelli A, Tubazio I, Colombo F. Sclerosing mesenteritis: a rare disease involving the adipose tissue of the bowel mesentery. Intern Emerg Med 2024:10.1007/s11739-023-03510-6. [PMID: 38194001 DOI: 10.1007/s11739-023-03510-6] [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: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Nicola Flor
- Unità Operativa Di Radiologia, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Francesca Ferretti
- Unità Operativa Di Gastroenterologia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Alessandro Pellegrinelli
- Unità Operativa Di Anatomia Patologica, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Igor Tubazio
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Francesco Colombo
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
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8
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Kuang AG, Sperling G, Liang TZ, Lu Y, Tan D, Bollin K, Johnson DB, Manzano JGM, Shatila M, Thomas AS, Thompson JA, Zhang HC, Wang Y. Sclerosing mesenteritis following immune checkpoint inhibitor therapy. J Cancer Res Clin Oncol 2023; 149:9221-9227. [PMID: 37195298 DOI: 10.1007/s00432-023-04802-2] [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] [Received: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Sclerosing mesenteritis (SM), a fibroinflammatory process of the mesentery, can rarely occur after immune checkpoint inhibitor (ICI) therapy; however, its clinical significance and optimal management are unclear. We aimed to assess the characteristics and disease course of patients who developed SM following ICI therapy at a single tertiary cancer center. METHODS We retrospectively identified 12 eligible adult cancer patients between 05/2011 and 05/2022. Patients' clinical data were evaluated and summarized. RESULTS The median patient age was 71.5 years. The most common cancer types were gastrointestinal, hematologic, and skin. Eight patients (67%) received anti-PD-1/L1 monotherapy, 2 (17%) received anti-CTLA-4 monotherapy, and 2 (17%) received combination therapy. SM occurred after a median duration of 8.6 months from the first ICI dose. Most patients (75%) were asymptomatic on diagnosis. Three patients (25%) reported abdominal pain, nausea, and fever and received inpatient care and corticosteroid treatment with symptom resolution. No patients experienced SM recurrence after the completion of corticosteroids. Seven patients (58%) experienced resolution of SM on imaging. Seven patients (58%) resumed ICI therapy after the diagnosis of SM. CONCLUSIONS SM represents an immune-related adverse event that may occur after initiation of ICI therapy. The clinical significance and optimal management of SM following ICI therapy remains uncertain. While most cases were asymptomatic and did not require active management or ICI termination, medical intervention was needed in select symptomatic cases. Further large-scale studies are needed to clarify the association of SM with ICI therapy.
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Affiliation(s)
- Andrew G Kuang
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Sperling
- The University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, USA
| | - Tom Z Liang
- Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Lu
- Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dongfeng Tan
- Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathryn Bollin
- Division of Hematology and Oncology, Scripps MD Anderson Cancer Center, La Jolla, CA, USA
| | - Douglas B Johnson
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna-Grace M Manzano
- Department of Hospital Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Malek Shatila
- Department of Gastroenterology, Hepatology, & Nutrition, Division of Internal Medicine, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Anusha S Thomas
- Department of Gastroenterology, Hepatology, & Nutrition, Division of Internal Medicine, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - John A Thompson
- Divison of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Hao Chi Zhang
- Department of Gastroenterology, Hepatology, & Nutrition, Division of Internal Medicine, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, & Nutrition, Division of Internal Medicine, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Celis Pinto JC, Hernández Peláez L, Mendoza Pacas G, Mayordomo Colunga J, Balbín M, Pitiot A, Torres-Rivas HE, Blanco Lorenzo V. Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report. Autops Case Rep 2023; 13:e2023434. [PMID: 37292389 PMCID: PMC10247287 DOI: 10.4322/acr.2023.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 06/10/2023]
Abstract
Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.
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Affiliation(s)
- Juan Carlos Celis Pinto
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
| | - Lucía Hernández Peláez
- Hospital Universitario Central de Asturias (HUCA), Pediatric Department, Oviedo, Asturias, Spain
| | - Guillermo Mendoza Pacas
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
| | - Juan Mayordomo Colunga
- Hospital Universitario Central de Asturias (HUCA), Pediatric Intesive Care Unit, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Cataluña, Spain
| | - Milagros Balbín
- Hospital Universitario Central de Asturias (HUCA), Medicine Laboratory, Oviedo, Asturias, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Molecular Oncology Laboratory, Oviedo, Asturias, Spain
- Instituto de Investigación Biosanitaria de Asturias, Oviedo, Asturias, Spain
| | - Ana Pitiot
- Hospital Universitario Central de Asturias (HUCA), Medicine Laboratory, Oviedo, Asturias, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Molecular Oncology Laboratory, Oviedo, Asturias, Spain
- Instituto de Investigación Biosanitaria de Asturias, Oviedo, Asturias, Spain
| | | | - Verónica Blanco Lorenzo
- Hospital Universitario Central de Asturias (HUCA), Pathology Department, Oviedo, Asturias, Spain
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Chennavasin P, Gururatsakul M. Idiopathic sclerosing mesenteritis presenting with small bowel volvulus in a patient with antiphospholipid syndrome: A case report. World J Clin Cases 2023; 11:3304-3310. [PMID: 37274053 PMCID: PMC10237130 DOI: 10.12998/wjcc.v11.i14.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Sclerosing mesenteritis is a rare disorder involving inflammation of the mesentery. Its etiology remains unclear, but it is believed to be associated with previous abdominal surgery, trauma, autoimmune disorders, infection, or malignancy. Clinical manifestations of sclerosing mesenteritis are varied and include chronic abdominal pain, bloating, diarrhea, weight loss, formation of an intra-abdominal mass, bowel obstruction, and chylous ascites. Here, we present a case of idiopathic sclerosing mesenteritis with small bowel volvulus in a patient with antiphospholipid syndrome.
CASE SUMMARY A 68-year-old female presented with recurrent small bowel obstruction. Imaging and pathological findings were consistent with sclerosing mesenteritis causing mesenteric and small bowel volvulus. Computed tomography scans also revealed pulmonary embolism, and the patient was started on a high dose of corticosteroid and a therapeutic dose of anticoagulants. The patient subsequently improved clinically and was discharged. The patient was also diagnosed with antiphospholipid syndrome after a hematological workup.
CONCLUSION Sclerosing mesenteritis is a rare condition, and patients with no clear etiology should be considered for treatment with immunosuppressive therapy.
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Affiliation(s)
- Papawee Chennavasin
- Department of Surgery, Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Montri Gururatsakul
- Department of Gastroenterology and Hepatology, Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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11
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Nguyen T, Stewart B, Patel J, Dass B. Goiter and Abdominal Mass: A Rare Presentation of Riedel's Thyroiditis. BMJ Case Rep 2023; 16:e254558. [PMID: 37185314 PMCID: PMC10151917 DOI: 10.1136/bcr-2023-254558] [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: 05/17/2023] Open
Abstract
Riedel's thyroiditis (RT) is a rare inflammatory autoimmune disease, often associated with various forms of systemic fibrosis such as sclerosing mesenteritis (SM). A woman in her late 30s presented with a diffusely enlarged firm goiter and a mesenteric mass complicated by biliary obstruction and hydronephrosis. Labs and thyroid ultrasound were consistent with autoimmune thyroiditis. Abdominal imaging demonstrated a mesenteric mass that encased mesenteric vessels and ureter. Flow cytometry and infectious workup were negative. Both thyroid and mesenteric biopsies revealed dense fibrosis with patchy lymphoplasmacytic aggregates, no evidence of carcinoma, lymphoma, or IgG4-related disease, which confirmed diagnoses of RT and SM. She improved clinically with steroids. The coincidental timing of thyroid enlargement and the mesenteric mass, and the similarity in histology suggest an association between RT and SM. Overall, the case highlights the challenges in diagnosing RT given its rarity and emphasises the importance of early treatment to prevent systemic involvement.
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Affiliation(s)
- Thao Nguyen
- Medicine, University of Florida, Gainesville, Florida, USA
| | - Brian Stewart
- Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Jaymin Patel
- Medicine, University of Florida, Gainesville, Florida, USA
| | - Bhagwan Dass
- Medicine, University of Florida, Gainesville, Florida, USA
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12
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Gande S, Nguyen NN, Stead TS, Mangal R, Ganti L. Sclerosing Mesenteritis Managed Conservatively With Prednisone. Cureus 2023; 15:e35419. [PMID: 36987491 PMCID: PMC10040226 DOI: 10.7759/cureus.35419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
The authors present the case of a middle-aged lady with two weeks of abdominal pain. Computed tomography imaging revealed sclerosing mesenteritis. Sclerosing mesenteritis is also known as mesenteric panniculitis and is a chronic fibrosing inflammatory disease that primarily affects the adipose tissue of the mesentery in the small intestine and colon. The clinical presentation, imaging findings, differential diagnosis, and therapeutic management are presented in this report. In our patient's case, she was able to be managed conservatively, without the need for surgery. This reflects the most benign and self-limiting natural history of the disease.
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Affiliation(s)
| | | | - Thor S Stead
- Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Rohan Mangal
- Medicine, Johns Hopkins University, Baltimore, USA
- Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Latha Ganti
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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13
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Yamamoto K, Honda H, Ogawa H, Otsuka F. Key signs indicating mesenteric panniculitis. Clin Case Rep 2022; 10:e6654. [PMID: 36514474 PMCID: PMC9731291 DOI: 10.1002/ccr3.6654] [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: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
Since patients with mesenteric panniculitis (MP) present non-specific symptoms, diagnosing MP is challenging. We describe a 45-year-old man who developed MP with radiologic findings of a "fat ring sign" and a "tumoral pseudocapsule sign." These signs shown in the present case are crucial for a precise diagnosis of MP.
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Affiliation(s)
- Koichiro Yamamoto
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroyuki Honda
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroko Ogawa
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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14
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Mesenteric panniculitis is associated with cardiovascular risk-factors: A case-control study. Dig Liver Dis 2022; 54:1657-1661. [PMID: 35853820 DOI: 10.1016/j.dld.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study evaluated the prevalence of cardiovascular risk-factors in patients with mesenteric panniculitis. AIMS To determine whether cardiovascular risk-factors and mesenteric panniculitis are associated. METHODS Retrospective, matched case-control study of patients referred to Meir Medical Center, Israel, 2014-2019, who underwent computerized tomography scan, were diagnosed mesenteric panniculitis by radiologic criteria. They were compared to two, matched case-control groups: hospitalized patients without mesenteric panniculitis and the general population based on Israeli Ministry of Health surveys. Patients with active malignancy, IBD or significant intra-abdominal morbidity were excluded. RESULTS Of 376 patients with mesenteric panniculitis diagnosed by computerized tomography, 187 were included. Compared to hospital patients, they had higher incidence of dyslipidemia (77.5%/56.7%), hypertension (52.4%/40.6%), obesity (body mass index>30) (60.4%/30.5%) and nonalcoholic fatty liver disease (42.2%/16.6%). Similar differences were observed compared to the general population. In multivariable logistic regression, dyslipidemia, obesity, and nonalcoholic fatty liver disease were independent predictors for mesenteric panniculitis. CONCLUSIONS Patients with mesenteric panniculitis have more cardiovascular risk-factors compared to a case-control group and to the general population. This suggests that mesenteric panniculitis is clinically significant and may be part of the metabolic morbidity burden. This association should be further explored.
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15
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Artigues Serra F, García-Gasalla M, Campins A, González de Cabo M, Morales R, Peña RR, Gallegos MC, Riera M. Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report. Medicine (Baltimore) 2022; 101:e30351. [PMID: 36086677 PMCID: PMC10980495 DOI: 10.1097/md.0000000000030351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Since its first identification in the early 1990s, Mycobacterium genavense has been considered and opportunistic pathogen. It mainly causes gastrointestinal symptoms, but also disseminated infections in severely immunosuppressed patients. Sclerosing mesenteritis is a long-term complication with high morbidity and mortality. As it is a rare condition, there are no specific guidelines for its management. We report a challenging case of persistent M. genavense infection, and propose surgery as an alternative treatment strategy. PATIENT CONCERNS A 38-year-old Caucasian man presented to the emergency room with fever, abdominal pain, and night sweats for 3 months. HIV screening revealed a previously unknown HIV-1 infection, with a CD4 cell count of 216 cell/µL and viral load of 361.000 copies/mL at diagnosis. A body CT-scan showed mild splenomegaly as well as mesenteric and retroperitoneal enlarged lymph nodes. Fine needle aspiration revealed the presence of acid-fast bacilli, but mycobacterial cultures were negative. In the second sample, 16S RNA sequencing yielded a diagnosis of M. genavense infection. Despite 2 years of corticosteroids and antimycobacterial treatment excluding rifampicin due to a severe cutaneous reaction, there was no clinical improvement and an increase in the mesenteric lymph node size was observed, with a sclerosing transformation of the mesentery. A surgical approach was proposed to release small bowel loops and to remove fibrin. A second surgery was required due to an acute peritonitis ought to yeyunal segmental isquemia and perforation. Finally, the patient evolved favorably, and antimycobacterial drugs were suspended without relapse. LESSONS Despite a prolonged multidrug strategy, some patients develop persistent M. genavense infection. Once sclerosing mesenteritis is established, clinicians have few treatment options. Surgery should be considered in patients with sclerosing mesenteritis or bowel obstruction. The combination of medical and surgical treatment could be a potential cure for these patients.
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Affiliation(s)
- Francisca Artigues Serra
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | - Mercedes García-Gasalla
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | - Antoni Campins
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | | | - Rafael Morales
- Peritoneal Surface Malignancies Unit, General and Digestive Surgery Department, Hospital Universitari Son Espases-IdISba, Palma, Spain
| | - Rebecca Rowena Peña
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | | | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
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16
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Mandala S, Kodati R, Tadepalli A, Reddy C, Kalyan S. An Unusual Cause of Acute Abdominal Pain in Coronavirus Disease (COVID-19): Report of Two Cases. Indian J Crit Care Med 2022; 26:1045-1048. [PMID: 36213717 PMCID: PMC9492738 DOI: 10.5005/jp-journals-10071-24310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) is an infectious disease caused by coronavirus/2019-nCoV. It primarily manifests as lung infection, with fever and respiratory tract symptoms. Extrapulmonary complications affecting multiple organs are commonly seen, especially in critically ill patients. The reported gastrointestinal (GI) complications include transaminitis, acute pancreatitis, mesenteric ischemia, GI bleed, and ileus. Here, we report two cases of acute abdominal pain in patients with COVID-19 in their second week of illness. One patient had mild COVID-19 disease and the other had severe disease. Both patients had diffuse abdominal tenderness and raised inflammatory markers. The diagnosis of mesenteric panniculitis (MP) was made radiologically, and demonstrated with the presence of increased density of the mesentery with fat stranding (misty mesentery). Glucocorticoid administration resulted in the complete resolution of pain. They remained pain-free at 3 months of follow-up.
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Affiliation(s)
- Sudeepthi Mandala
- Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India
| | - Rakesh Kodati
- Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India
- Rakesh Kodati, Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India, Phone: +91 9781994022, e-mail:
| | - Anuradha Tadepalli
- Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India
| | - Chandana Reddy
- Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India
| | - Shruthi Kalyan
- Department of Radiodiagnosis, STAR Hospitals, Hyderabad, Telangana, India
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17
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Sharawi S, Graffeo V, Goebel LJ. Sclerosing Mesenteritis: A Rare Cause of Abdominal Pain. Cureus 2022; 14:e28573. [PMID: 36185930 PMCID: PMC9520956 DOI: 10.7759/cureus.28573] [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] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome. A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated with nausea, alternating constipation and diarrhea with occasional mucus, and bloating. She used bismuth subsalicylate and ondansetron with temporary relief. Upper endoscopy and colonoscopy were unrevealing. Initially, she was felt to have irritable bowel. Later she presented with nausea and right upper quadrant pain and underwent cholecystectomy. When her pain recurred, the patient had a CT abdomen and pelvis which showed multiple sub-centimeter mesenteric lymph nodes with surrounding haziness and stranding in the root of the mesentery consistent with SM. The patient had a pannus biopsy showing fat necrosis that confirmed the diagnosis. She continued to have waxing and waning symptoms over several years and in the interim was diagnosed with melanoma limited to the skin. The patient had a particularly severe episode of abdominal pain prompting a repeat CT scan with a subsequent biopsy of an enlarged left para-aortic lymph node that revealed lymphoma. Our patient’s diagnosis of SM was delayed as her symptoms were mistaken for irritable bowel syndrome. Worsening symptoms should alert clinicians to an alternate diagnosis such as SM. There are characteristic radiographic findings on CT scans and biopsy of the lesions. SM’s association with neoplastic diseases such as lymphoma, melanoma, colorectal, and prostate cancer is controversial, however, practitioners should be aware of this possibility and consider biopsy for any suspicious lesions.
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18
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Wagner C, Dachman A, Ehrenpreis ED. Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition. Clin Colon Rectal Surg 2022; 35:342-348. [PMID: 35966977 PMCID: PMC9365492 DOI: 10.1055/s-0042-1743588] [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: 11/03/2022]
Abstract
Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis. There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions. While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.
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Affiliation(s)
- Christopher Wagner
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Abraham Dachman
- Department of Radiology, University of Chicago Hospital, Chicago, Illinois
| | - Eli D. Ehrenpreis
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
- Department of Medicine, Rosalind Franklin University Medical School, North Chicago, Illinois
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19
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Cortés P, Ghoz HM, Mzaik O, Alhaj Moustafa M, Bi Y, Brahmbhatt B, Daoud N, Pang M. Colchicine as an Alternative First-Line Treatment of Sclerosing Mesenteritis: A Retrospective Study. Dig Dis Sci 2022; 67:2403-2412. [PMID: 34086165 DOI: 10.1007/s10620-021-07081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Sclerosing mesenteritis is a rare condition characterized by chronic inflammation and fibrotic changes of the mesentery. AIMS To determine the long-term management and outcomes of patients with sclerosing mesenteritis. METHODS Patients with biopsy-proven sclerosing mesenteritis at the Mayo Clinic between January 2006 and December 2016 were identified. Clinical data were collected retrospectively. RESULTS One hundred and three patients were identified, median age 68.0 years (range 35.0-85.3). Most patients were symptomatic (87.4%) at presentation. Patients received no treatment (52.4%), medical therapy (42.7%) or surgery (4.9%) on initial diagnosis. The most common initial regimens were prednisone plus tamoxifen (41.9%), prednisone alone (23.3%), and prednisone plus colchicine (11.6%) with 55.6%, 57.2%, and 60% of patients improving, respectively, p = 0.85 for a difference in response rates. At least half of the patients responded to prednisone plus tamoxifen, prednisone plus colchicine, or prednisone alone at 6.0, 7.2, and 8.4 months, respectively. At a median follow-up of 45.6 months (95% CI 24.1-69.7), 65.4% of patients were receiving medical therapy. Of those receiving tamoxifen-based, steroid-based, or steroid-sparing regimens, 100%, 87.5%, and 77.8% had improved by their last follow-up appointment respectively, p = 0.15. CONCLUSION Prednisone plus colchicine has a similar efficacy to prednisone plus tamoxifen for the initial and long-term treatment of sclerosing mesenteritis. The majority of patients were initiated on medical therapy over the long term with most reporting symptomatic improvement within a year. Death from SM was rare.
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Affiliation(s)
- Pedro Cortés
- Division of Medicine, Mayo Clinic Florida, Jacksonville, 32224, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | | | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Nader Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Maoyin Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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20
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Hussain I, Ishrat S, Aravamudan VM, Khan SR, Mohan BP, Lohan R, Abid MB, Ang TL. Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29143. [PMID: 35512070 PMCID: PMC9276205 DOI: 10.1097/md.0000000000029143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. METHODS MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. RESULTS Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group. CONCLUSION This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
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Affiliation(s)
- Ikram Hussain
- Division of Gastroenterology, Department of Medicine, Woodlands Health Campus, Singapore
| | | | | | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Babu P. Mohan
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, UT
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Muhammad Bilal Abid
- Divisions of Infectious Diseases & Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
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21
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Abstract
IgG4-related conditions affecting the digestive tract are part of a multi-organ fibro-inflammatory disorder termed IgG4-related disease (IgG4-RD), with autoimmune pancreatitis and IgG4-related cholangitis being the most prominent manifestations. Gastrointestinal symptoms include jaundice, weight loss, abdominal pain, biliary strictures, and pancreatic and hepatic masses that mimic malignant diseases. IgG4-RD manifestations occur less frequently elsewhere in the digestive tract, namely in the oesophagus, retroperitoneum or intestine. Evidence-based European guidelines frame the current state-of-the-art in the diagnosis and management of IgG4-related digestive tract disease. Diagnosis is based on histology (if available), imaging, serology, other organ involvement and response to therapy (HISORt criteria). Few biomarkers beyond serum IgG4 concentrations are reliable. The first-line therapy (glucocorticoids) is swiftly effective but disease flares are common at low doses or after tapering. Second-line therapy might consist of other immunosuppressive drugs such as thiopurines or rituximab. Further trials, for example, of anti-CD19 drugs, are ongoing. Although an association between IgG4-RD and the development of malignancies has been postulated, the true nature of this relationship remains uncertain at this time.
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22
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Piombino E, D'Agata C, Picardo MC, Caltavuturo C, Magro G, Colarossi C, Memeo L. Sclerosing Mesenteritis, a Rare Cause of Mesenteric Mass in a Young Adult: A Case Report. Front Surg 2021; 8:722312. [PMID: 34490340 PMCID: PMC8417936 DOI: 10.3389/fsurg.2021.722312] [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: 06/08/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific.
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Affiliation(s)
- Eliana Piombino
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Costanza D'Agata
- Surgical Oncology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Maria Carolina Picardo
- Surgical Oncology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Claudia Caltavuturo
- Radiology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Cristina Colarossi
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Lorenzo Memeo
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
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23
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Eichstädt D, Kopdag H, MacMillan C, Stiedenroth LM, Viehweger F, von Wichert G. [Motility disorder and weight loss in a 71-year-old male patient]. Internist (Berl) 2021; 62:1237-1242. [PMID: 34309722 DOI: 10.1007/s00108-021-01095-w] [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] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
A 71-year-old man presented to this clinic for evaluation of an unclear abdominal tumor. He complained of abdominal pain, weight loss and motility disorders, which began some weeks previously. Ultrasound and computed tomography (CT) scans showed a large mesenterial space-occupying lesion with accompanying lymphadenopathy, slight accumulation of ascites and venous congestion. For confirmation of the suspected diagnosis of a sclerosing mesenteritis and exclusion of a lymphoma a laparoscopy was carried out with excision of tissue. The material was not adequately representative so that a laparotomy was carried out for removal of a new tissue specimen. The tissue specimen confirmed the rare diagnosis of sclerosing mesenteritis and due to the complaints a pharmaceutical treatment with prednisone and tamoxifen was initiated.
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Affiliation(s)
- Dominique Eichstädt
- Abteilung für Innere Medizin, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
| | - Hakan Kopdag
- Abteilung für Innere Medizin, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - Cary MacMillan
- Abteilung für Radiologie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | | | - Florian Viehweger
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Götz von Wichert
- Abteilung für Innere Medizin, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
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24
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Pandya A, Kotecha K, Li E, Gill AJ, Samra JS, Mittal A. Sheep in wolf's clothing: A case of mistaken identity-Intestinal mesenteritis. ANZ J Surg 2021; 92:287-289. [PMID: 34151500 DOI: 10.1111/ans.17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Advait Pandya
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Edward Li
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony J Gill
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jaswinder S Samra
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anubhav Mittal
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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25
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A case of immunoglobulin G4-related sclerosing mesenteritis without other organ involvement. Clin J Gastroenterol 2021; 14:1411-1418. [PMID: 34097250 DOI: 10.1007/s12328-021-01451-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
A 64-year-old man presented to our hospital with abdominal pain and 4-5 episodes of watery diarrhea per day for 2 months. Abdominal ultrasound examination revealed a mass in the peritoneal cavity, and computed tomography showed a 13.4 cm mass in the mesentery and a 3 cm mass in the mesocolon. The patient underwent laparoscopic partial resection for diagnosis. Microscopically, abundant fibrosis and numerous immunoglobulin (Ig) G4-positive plasma cells were observed. The serum level of IgG4 was 665 mg/dl postoperatively. These findings suggested that the lesion was consistent with IgG4-related sclerosing mesenteritis. Oral steroids resulted in rapid disappearance of symptoms and a decrease in masses. Recently, sclerosing mesenteritis are reported as IgG4-related disease or mimicking IgG4-related disease but multiple lesions rarely occur in the same organ. We report a case of IgG4-related sclerosing mesenteritis with multiple lesions without involvement of other organs, such as the pancreas and salivary glands.
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26
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Pathirannehalage Don C, Sforza D, Siragusa L, Sensi B, Ciancio Manuelli M, Telesca R, Savino L, Ferrazzoli V, Grande S, Villa M, Grande M. Ileal Neuroendocrine Tumor in a Patient with Sclerosing Mesenteritis: Which Came First? AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931372. [PMID: 34092781 PMCID: PMC8196396 DOI: 10.12659/ajcr.931372] [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: 11/09/2022]
Abstract
BACKGROUND Jejunoileal neuroendocrine tumors (JI-NETs) are rare tumors that can be associated with mesenteric fibrosis. This case report is of an incidental finding of a JI-NET in a patient who was previously misdiagnosed with sclerosing mesenteritis. CASE REPORT A 42-year-old man was admitted to our institution with diffuse abdominal pain and clinical and radiographic signs of bowel obstruction. He had a previous diagnosis of sclerosing mesenteritis, which had been histologically diagnosed after an exploratory laparoscopy performed in 2009 for recurrent acute abdominal pain. He was also annually monitored through computed tomography scans for an incidentally discovered, gradually enlarging mesenteric mass for which a "wait and watch" management approach was adopted. After a period of fasting and observation, the patient underwent an urgent exploratory laparotomy because of his worsening condition. Intraoperatively, an ileocecal resection was performed, along with excision of the known mesenteric mass. The pathology report revealed an ileal NET with nodal metastases within the mesentery and mesenteric tumor deposits (pT3N1). CONCLUSIONS JI-NETs are rare entities, which are usually encountered as incidental findings or in patients with unspecific abdominal pain. Our case represents a probable delayed diagnosis of JI-NET in the context of sclerosing mesenteritis; therefore, a possible association between these 2 conditions should be investigated.
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Affiliation(s)
| | - Daniele Sforza
- Department of Emergency Surgery, Policlinico Tor Vergata, Rome, Italy
| | | | - Bruno Sensi
- Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | | | - Rossana Telesca
- Department of Histopathology, Policlinico Tor Vergata, Rome, Italy
| | - Luca Savino
- Department of Histopathology, Policlinico Tor Vergata, Rome, Italy
| | - Valentina Ferrazzoli
- Neuroradiology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Simona Grande
- Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Massimo Villa
- Department of Emergency Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Michele Grande
- Department of Emergency Surgery, Policlinico Tor Vergata, Rome, Italy
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27
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Mrozikiewicz-Rakowska B, Zygmunciak M, Głażewski T, Mieczkowski M, Podgórska J, Rowiński O, Czupryniak L. The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common). AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930453. [PMID: 34054123 PMCID: PMC8174387 DOI: 10.12659/ajcr.930453] [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: 12/01/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain Medication: Prednisone Clinical Procedure: CT scan • MRI Specialty: Endocrinology and Metabolic
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Affiliation(s)
| | - Mateusz Zygmunciak
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Tomasz Głażewski
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Mateusz Mieczkowski
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Joanna Podgórska
- Second Department of Clinical Radiology, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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28
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Cohen-Aubart F, Ungureanu I, Razanamahery J, Charlotte F, Valmary-Degano S, Hélias-Rodzewicz Z, Cazals-Hatem D, Dartigues P, Delage-Corre M, Selves J, Tas P, Humbert S, Malakhia A, Kunnamo M, Veresezan L, Prokopiou C, Seeber A, Tazi A, Donadieu J, Lucidarme O, Haroche J, Emile JF. Peritoneal or mesenteric tumours revealing histiocytosis. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000622. [PMID: 34020934 PMCID: PMC8144026 DOI: 10.1136/bmjgast-2021-000622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 05/01/2021] [Indexed: 01/31/2023] Open
Abstract
Objective Peritoneal or mesenteric tumours may correspond to several tumour types or tumour-like conditions, some of them being represented by histiocytosis. This rare condition often poses diagnostic difficulties that can lead to important time delay in targeted therapies. Our aim was to describe main features of histiocytoses with mesenteric localisation that can improve the diagnostic process. Design We performed a retrospective study on 22 patients, whose peritoneal/mesenteric biopsies were infiltrated by histiocytes. Results Abdominal pain was the revealing symptom in 10 cases, and 19 patients underwent surgical biopsies. The diagnosis of histiocytosis was proposed by initial pathologists in 41% of patients. The other initial diagnoses were inflammation (n=7), sclerosing mesenteritis (n=4) and liposarcoma (n=1). The CD163/CD68+CD1a- histiocytes infiltrated subserosa and/or deeper adipose tissues in 16 and 14 cases, respectively. A BRAFV600E mutation was detected within the biopsies in 11 cases, and two others were MAP2K1 mutated. The final diagnosis was histiocytosis in 18 patients, 15 of whom had Erdheim-Chester disease. The median diagnostic delay of histiocytosis was 9 months. Patients treated with BRAF or MEK inhibitors showed a partial response or a stable disease. One patient died soon after surgery, and five died by the progression of the disease. Conclusion Diagnosis of masses arising in the mesentery should be carefully explored as one of the possibilities in histiocytosis. This diagnosis is frequently missed on mesenteric biopsies. Molecular biology for detecting the mutations in BRAF or in genes of the MAP kinase pathway is a critical diagnostic tool.
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Affiliation(s)
- Fleur Cohen-Aubart
- Sorbonne University, Paris, Île-de-France, France.,Service de Médecine Interne et Centre National de Référence Maladies Systémiques Rares et Histiocytoses, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Irena Ungureanu
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France.,Department of Pathology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre Dijon, Dijon, France
| | - Frédéric Charlotte
- Department of Pathology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Séverine Valmary-Degano
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Zofia Hélias-Rodzewicz
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France.,EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | | | - Peggy Dartigues
- Department of Pathology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | | | - Janick Selves
- Department of Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
| | - Patrick Tas
- Department of Pathology, CHU Pontchaillou, Rennes, Bretagne, France
| | - Sebastien Humbert
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre Dijon, Dijon, France
| | - Alexandre Malakhia
- Department of Radiology, University Hospital Centre Besancon, Besancon, France
| | - Merja Kunnamo
- Department of Medicine, Central Finland Central Hospital, Jyvaskyla, Central Finland, Finland
| | - Liana Veresezan
- Department of Pathology, Centre Henri Becquerel, Rouen, Haute-Normandie, France
| | | | - Andreas Seeber
- Medical University of Innsbruck, Innsbruck, Austria.,Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Innsbruck, Austria
| | - Abdellatif Tazi
- Centre National de Référence des Histiocytoses, Department of Pneumology, Hospital Saint-Louis, Paris, Île-de-France, France.,FR-75006, Université de Paris, Paris, Île-de-France, France
| | - Jean Donadieu
- EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France.,Department of Pediatric Hematology and Oncology, Centre de Référence des Histiocytoses, Hôpital Armand-Trousseau, Paris, Île-de-France, France
| | - Olivier Lucidarme
- Department of Radiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.,CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne University, Paris, Île-de-France, France
| | - Julien Haroche
- Sorbonne University, Paris, Île-de-France, France.,Service de Médecine Interne et Centre National de Référence Maladies Systémiques Rares, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Jean-François Emile
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France .,EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
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29
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A 67-Year-Old Woman With Abdominal Pain and Dyspnea. Chest 2021; 159:e309-e312. [PMID: 33965154 DOI: 10.1016/j.chest.2020.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/05/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
CASE PRESENTATION A 67-year-old woman presented to her primary physician with a year of periumbilical abdominal discomfort with diarrhea, bloating, and unintentional weight loss. While undergoing workup for the abdominal pain, she presented to the ED with dyspnea that worsened over a few weeks. She had no associated chest pain, lower extremity edema, fevers, or chills, but endorsed orthopnea. The patient's medical history included hypothyroidism and diabetes mellitus. Her family history was significant for coronary disease in her father and hypertension in her mother. She had no recent travel; she is a nonsmoker and rare alcohol drinker. She worked in administration.
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30
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de Sire R, Imperatore N, D'Armiento M, Coccoli P, Di Luna I, Ricciolino S, Castiglione F, Rispo A. Ultrasonography-Based Management of Sclerosing Mesenteritis: From Diagnosis to Follow-Up. Int Med Case Rep J 2021; 14:187-190. [PMID: 33814933 PMCID: PMC8009549 DOI: 10.2147/imcrj.s290507] [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: 01/19/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
Sclerosing mesenteritis (SM) is an idiopathic disorder affecting mesentery, characterized by fat necrosis, chronic inflammation and fibrosis. The clinical presentation varies from asymptomatic cases to acute abdomen. The diagnosis is suggested by imaging but can be definitely established only by biopsies. In this paper, we discuss ultrasonography-based management of SM.
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Affiliation(s)
- Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.,Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Maria D'Armiento
- Pathology, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Pietro Coccoli
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Imma Di Luna
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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31
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Aguilar Chalacán MF, Vela Benalcazar C, Recalde JL, Negrete R. Mesenteritis esclerosante: diagnóstico y tratamiento. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El objetivo de este artículo es dar a conocer el caso de un paciente con diagnóstico de mesenteritis esclerosante quien cursó con cuadro de obstrucción intestinal.
Descripción del caso. Paciente masculino de 28 años de edad, quien se presenta con cuadro clínico sugestivo de obstrucción intestinal, por lo que se decide resolución quirúrgica. Durante la cirugía se observa una zona fibrótica y adherente del intestino delgado, asociada a un mesenterio engrosado. El exámen histopatológico de la pieza quirúrgica confirmó el diagnóstico de mesenteritis esclerosante.
Discusión. La mesenteritis esclerosante es una patología de baja incidencia, y su forma de presentación es inespecífica, por lo que el diagnóstico definitivo es histopatológico. La tomografía es útil para el diagnóstico cuando se tiene la sospecha clínica. Puede optarse por el tratamiento quirúrgico para los casos que se presenten con clínica de obstrucción intestinal, o en caso contrario, el tratamiento médico a base de fármacos inmunosupresores e inmunomoduladores ha demostrado ser efectivo. De acuerdo con los diferentes estudios publicados hasta el momento, se observa una adecuada respuesta, independientemente del tratamiento empleado.
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32
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Debilitating Manifestation of a Disease with Multiple Names: A Severe Case of Sclerosing Mesenteritis. Case Rep Gastrointest Med 2021; 2021:6629424. [PMID: 33628534 PMCID: PMC7884159 DOI: 10.1155/2021/6629424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare inflammatory condition with unknown etiology that affects the mesenteric adipose tissue. We present a case of a 49-year-old male with severe abdominal pain who underwent abdominal biopsy confirming the presence of adipose inflammation and necrosis. The diagnosis of SM was made, and the patient was treated with prednisone and tamoxifen. As this condition is rare, there are no standard guidelines for management. This case aims to outline a possible treatment plan.
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33
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Láinez-Ramos-Bossini AJ, Gómez-Huertas M, Gálvez-López R. Mesenteric panniculitis and abdominal pain: A casual association? Retrospective case series analysis. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45 Suppl 1:143-144. [PMID: 33545236 DOI: 10.1016/j.gastrohep.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Jesús Láinez-Ramos-Bossini
- Sección de Radiología Abdominal, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Radiología, Universidad de Granada, Granada, España.
| | - María Gómez-Huertas
- Sección de Radiología Abdominal, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Regina Gálvez-López
- Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España
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34
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Serena TJ, Solomon Schnurr CA, Pui JC, Gerken JR. Surgical Excision of Sclerosing Mesenteritis, Exploration of an Unknown Mesenteric Mass. Cureus 2021; 13:e12546. [PMID: 33564540 PMCID: PMC7863085 DOI: 10.7759/cureus.12546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Sclerosing mesenteritis is a rare and often benign condition characterized as a fibrotic disease consisting of non-suppurative inflammation of adipose tissue. Through mass effect, sclerosing mesenteritis can compromise the gastrointestinal lumen as well as mesenteric vessel integrity. There is a poor understanding of this disorder and its pathogenesis, which presents with various symptomatology and often without identification of inciting factors. Patients with sclerosing mesenteritis exhibit gastrointestinal and systemic manifestations including weight loss, fever, nausea, vomiting, diarrhea, and abdominal pain. This case presents a patient with a seven-month history of chronic, epigastric abdominal pain following laparoscopic surgery for acute uncomplicated appendicitis. The patient underwent work-up with computed tomography and magnetic resonance enterography that confirmed the presence of a mesenteric mass of unknown etiology located in the mid-epigastrium. Due to the inability to safely sample the mass, the patient underwent diagnostic laparoscopy, which was subsequently converted to an open procedure where excision of the mesenteric lesion was performed. Surgical pathology revealed fat necrosis with fibrosis, granulomatous inflammation, and dystrophic calcifications consistent with sclerosing mesenteritis. The patient was seen in follow-up with the resolution of her epigastric abdominal pain. This case report demonstrates a unique presentation of a symptomatic patient with a mesenteric mass not amenable to non-invasive biopsy. Complete excision of this lesser sac mass revealed sclerosis mesenteritis as the pathological cause.
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Affiliation(s)
- Thomas J Serena
- General Surgery/Vascular Surgery, Beaumont Health, Livonia, USA
| | | | - John C Pui
- Pathology, Beaumont Health, Farmington Hills, USA
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35
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Dhulaimi MA, Aldarmasi MA. RENAL, PELVIC AND MESENTERIC TUMORS WITH LOW SIGNAL INTENSITY ON T2-WEIGHTED MR IMAGE: A REVIEW. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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36
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Abstract
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
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37
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Reddington H, Ballinger Z, Abghari M, Modukuru V, Wallack M. Sclerosing Mesenteritis in a Patient Heterozygous for Factor V Leiden. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926332. [PMID: 33017382 PMCID: PMC7548109 DOI: 10.12659/ajcr.926332] [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: 11/15/2022]
Abstract
Patient: Male, 33-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain • diaphoresis • nausea • tachycardia Medication:— Clinical Procedure: Exploratory laparotomy Specialty: Surgery
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Affiliation(s)
| | | | - Michelle Abghari
- Department of Surgery, Metropolitan Hospital, New York City, NY, USA
| | - Venkat Modukuru
- Department of Surgery, Metropolitan Hospital, New York City, NY, USA
| | - Marc Wallack
- Department of Surgery, Metropolitan Hospital, New York City, NY, USA
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38
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Sá J, Evangelista C, Jorge CF, Silva J. Bilateral pleural effusions as the first sign of mesenteric panniculitis. BMJ Case Rep 2020; 13:13/7/e233423. [PMID: 32675113 DOI: 10.1136/bcr-2019-233423] [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
A 38-year-old woman presented to the emergency department with a history of thoracic pain and anorexia for 1 week. Thoracic CT scan showed bilateral pleural effusion, a thoracentesis was performed revealing a transudate liquid with polymorphonuclears and predominance of eosinophils. After admission, the patient developed abdominal pain and the abdominal CT scan showed densification of the mesenteric fat characteristic of mesenteric panniculitis (MP). The patient went through investigation for secondary causes of panniculitis including infection, neoplasia and autoimmune diseases, and no abnormalities were found. The patient was treated with corticosteroids over a period of 3 months with complete resolution and without any signs of remission or secondary cause of MP. Moreover, the patient remained asymptomatic for 2 years after being discharged, which strengthens the diagnosis of MP that presented with eosinophilic pleural effusion.
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Affiliation(s)
- Juliana Sá
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal .,University of Beira Interior, Covilhã, Portugal
| | - Céu Evangelista
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Clara F Jorge
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - João Silva
- Internal Medicine Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
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39
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Abstract
Mesenteric diseases are broadly separated into 2 groups: non-neoplastic and neoplastic. Common non-neoplastic mesenteric diseases include those involving the mesenteric vasculature and those of inflammatory processes. Mesenteric inflammatory processes can mimic a neoplastic process. Neoplastic diseases of the mesentery are rare. Generally, the morphology, behavior and diagnostic criteria for mesenteric tumors are similar to their soft tissue or organ-specific counterparts. Their recognition can be challenging because they sometimes are overlooked in differential diagnoses.
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Affiliation(s)
- Nooshin K Dashti
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, Nashville, TN 37232, USA
| | - Chanjuan Shi
- Department of Pathology, Duke University School of Medicine, Room 3119, Duke South, 40 Duke Medicine Circle, DUMC 3712, Durham, NC 27710, USA.
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40
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Elmohr MM, Elsayes KM, Pickhardt PJ. Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging. Br J Radiol 2020; 93:20200401. [PMID: 32516560 DOI: 10.1259/bjr.20200401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.
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Affiliation(s)
- Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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41
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Hori H, Fukuchi T, Sugawara H. Fat ring sign and tumoral pseudocapsule sign in idiopathic mesenteric panniculitis complicated by protein-losing enteropathy. J Gen Fam Med 2020; 21:157-158. [PMID: 32742909 PMCID: PMC7388662 DOI: 10.1002/jgf2.318] [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: 02/18/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old man complained of lower limb edema was diagnosed with mesenteric panniculitis because of fat ring sign and tumoral pseudocapsule sign on contrast-enhanced CT. Patient had edema due to protein-losing enteropathy associated with mesenteric panniculitis.
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Affiliation(s)
- Hiroshi Hori
- Division of General MedicineDepartment of Comprehensive Medicine 1Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Takahiko Fukuchi
- Division of General MedicineDepartment of Comprehensive Medicine 1Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Hitoshi Sugawara
- Division of General MedicineDepartment of Comprehensive Medicine 1Saitama Medical CenterJichi Medical UniversitySaitamaJapan
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42
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Asghar MS, Tauseef A, Naman D, Zafar M, Rasheed U, Khan N, Alvi H, Shaikh N. Mesenteric Panniculitis in a Patient with Homozygous Factor V Leiden Gene Mutation: A Case and Literature to Review. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors’ knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation.
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Affiliation(s)
| | - Abubakar Tauseef
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Durre Naman
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Maryam Zafar
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Uzma Rasheed
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Narmin Khan
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Haris Alvi
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimra Shaikh
- Liaquat National Hospital and Medical College, Karachi, Pakistan
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43
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Mesenteric panniculitis mimicking early recurrence at end-of-treatment evaluation in malignant lymphoma: Differentiation by active surveillance with F-18 FDG PET/CT imaging. Radiol Case Rep 2020; 15:1006-1010. [PMID: 32426085 PMCID: PMC7226656 DOI: 10.1016/j.radcr.2020.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022] Open
Abstract
Mesenteric panniculitis is a relatively rare fibro-inflammatory condition of the mesentery. In acute phase, it demonstrates avid uptake on Fluorine-18 FDG PET/CT (PET/CT). Thorough assessment is needed to differentiate from viable or recurrent disease in patients with malignant lymphoma because it mimics active lymphomatous disease on PET/CT. In this article, 3 illustrative cases of malignant lymphoma are presented. PET/CT demonstrated new FDG-avid mesenteric lesions at the end-of-treatment evaluation while the original disease showed significant response. Early recurrence was initially suspected, but together with clinical course and findings, active surveillance was opted. Sequential follow-up PET/CTs showed various patterns of metabolic activity over time; it can persist for months or more, or metabolic activity can fluctuate over time. Eventually benignity was confirmed in these cases. These cases underscore the importance of interpretation with clinical context and awareness of chronological metabolic changes of mesenteric panniculitis to determine proper management.
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44
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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.
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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
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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)
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Abstract
Mesenteric panniculitis (MP) is a relatively rare pathology characterized by idiopathic local chronic inflammation of adipose tissue, mainly affecting the mesentery of the small intestine. The purpose of the study is to describe a case of MP. A 60-year-old patient visited a rheumatologist due to the progressive deterioration of his condition for the last 4 months and revealed changes on the computed tomography of the abdominal cavity. Treatment protocol: methylprednisolone 8 mg/day, pantoprazole 40 mg/day; continue with antihypertensive drugs. On the background of treatment after 2 months, the temperature became normal, appetite improved, and weakness decreased, with no relapses of abdominal symptoms. Diagnosis of MP is a difficult task, which has to be solved by primary care specialists. This clinical case is an example of MP diagnosis and positive dynamics of the patient’s clinical condition during therapy.
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Lesser omental panniculitis: a possible cause of acute abdomen. Clin J Gastroenterol 2019; 13:191-197. [PMID: 31440908 DOI: 10.1007/s12328-019-01034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
We encountered a case of panniculitis of the lesser omentum in 2018 after a long time since our first case report in 2007. We reviewed previously reported three cases of lesser omental panniculitis including our first case to investigate its clinical characteristics. Total four cases were relatively young with mean age of 30, and had common chief complaint of considerable epigastric pain and tenderness. Blood test showed increase in the white blood cell, C-reactive protein, or erythrocyte sedimentation rate. Computed tomography revealed mass like change in the fat tissue outside of the lesser curvature of the stomach. Histopathological diagnosis was made in one operated patient. Other three patients were treated conservatively, and progressed well. Lesser omental panniculitis is a possible cause of acute abdomen, which shows characteristic images of computed tomography and probably good progress by conservative treatment.
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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.
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Miyaoka M, Ogura G, Nakamura N. Autopsy case of sclerosing mesenteritis with ossification and an aggressive clinical course. Pathol Int 2019; 69:508-510. [PMID: 31293034 DOI: 10.1111/pin.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Masashi Miyaoka
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Go Ogura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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