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Related Experiment Video

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A Mouse Model of Intestinal Partial Obstruction
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IgG4-related sclerosing mesenteritis causing bowel obstruction: a case report.

Atsushi Abe1,2, Tatsuya Manabe3, Nobuyoshi Takizawa4

  • 1Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. a-abe@surg1.med.kyushu-u.ac.jp.

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|November 1, 2016
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Summary

Sclerosing mesenteritis (SM), a rare mesenteric disease, is linked to IgG4-related disease (IgG4-RD). This case highlights IgG4-RD in SM, suggesting corticosteroids may help patients and prevent surgery.

Keywords:
IgG4-related SMIntestinal obstructionSclerosing mesenteritis

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Area of Science:

  • Gastroenterology
  • Pathology
  • Immunology

Background:

  • Sclerosing mesenteritis (SM) is a rare fibrosing condition of the small-bowel mesentery.
  • Recent findings suggest a strong association between SM and IgG4-related disease (IgG4-RD).

Purpose of the Study:

  • To describe a case of SM associated with IgG4-RD.
  • To emphasize the importance of considering IgG4-RD in the differential diagnosis of mesenteric masses.

Main Methods:

  • A patient with intestinal obstruction underwent surgical resection of a mesenteric mass.
  • Histopathological examination included immunohistochemistry for IgG4-positive plasma cells and Elastica van Gieson staining.
  • Diagnostic imaging utilized abdominal enhanced computed tomography (CT).

Main Results:

  • Histology revealed features consistent with SM, including spindle cells, fibrous stroma, lymphoplasmacytic infiltration, and lymphoid follicles.
  • Immunohistochemistry confirmed numerous IgG4-positive plasma cells (253/HPF) with a high IgG4/IgG ratio (~50%).
  • Obstructive phlebitis was identified via Elastica van Gieson staining, supporting IgG4-related SM.

Conclusions:

  • The case demonstrates SM associated with IgG4-RD, characterized by specific histological and immunohistochemical findings.
  • IgG4-RD should be considered in the differential diagnosis of unexplained mesenteric tumors.
  • Early identification of IgG4-RD in SM may allow for non-surgical management with corticosteroids, potentially avoiding extensive surgery.