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Watanabe T, Terai S, Tsukada T, Takeshita M, Matsui K, Amaya K, Kaji M, Maeda K, Shimizu K, Saito J, Mochizuki K, Uchiyama A. Sclerosing mesenteritis mimicking metachronous peritoneal metastases from descending colon adenocarcinoma. World J Surg Oncol 2017; 15:142. [PMID: 28764712 PMCID: PMC5540343 DOI: 10.1186/s12957-017-1214-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Sclerosing mesenteritis is a non-neoplastic inflammatory disease that occurs in the bowel mesentery. Distinguishing sclerosing mesenteritis from neoplasms may be difficult because of the clinical and radiographic similarities between the two disease entities. Case presentation We report a case of sclerosing mesenteritis mimicking peritoneal metastases of colorectal carcinoma. A 73-year-old man with stage II descending colon adenocarcinoma with poor prognostic features was found to have developed left lower abdominal quadrant masses on computed tomography (CT) 9 months after undergoing radical surgery. These masses were diagnosed as peritoneal metastases because they grew in size and displayed fluorodeoxyglucose (FDG) uptake 3 months later; thus, a laparotomy was performed. The masses, which were localized in the jejunal mesentery, were excised completely via segmental jejunal resection. Histopathological analysis confirmed that the masses were sclerosing mesenteritis. The patient showed no signs of sclerosing mesenteritis or colorectal carcinoma recurrence during follow-up. Conclusions In patients suspected of having localized peritoneal metastasis from malignancies, any masses must be sampled by surgical excisional biopsy and subsequently examined to rule out alternative diagnoses, such as sclerosing mesenteritis.
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Affiliation(s)
- Toshifumi Watanabe
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan.
| | - Shiro Terai
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masaki Takeshita
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koshi Matsui
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koji Amaya
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kiichi Maeda
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Junko Saito
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kentaro Mochizuki
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Akio Uchiyama
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
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Ehrenpreis ED, Roginsky G, Gore RM. Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms. World J Gastroenterol 2016; 22:10601-10608. [PMID: 28082812 PMCID: PMC5192271 DOI: 10.3748/wjg.v22.i48.10601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography (CT).
METHODS All abdominal CT scans performed at NorthShore University HealthSystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet (RadNet Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.
RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fifty-nine patients had mesenteric panniculitis (MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients (22.6%) had a known history of cancer at the time of their CT scan. Nineteen (5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these (14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MP-like findings on CT (36 cases, 36%), with follicular lymphoma being the most frequent subtype (17/36). A variety of solid tumors, most commonly prostate (7) and renal cell cancers (6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45 (80%), worsened in 6 (11%), and improved in 5 patients (9%). Positron emission tomography (PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients (5%).
CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.
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