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[Mesenteric panniculitis]
S Schwery1, P J Hangartner, T Vollrath
1Medizinische Klinik, Stadtspital Waid, Zürich.
Abstract:
A 70-year-old patient with a 6 x 6 x 12 cm mass involving the mesentery root is discussed. The pseudotumorous infiltration was detected by ultrasound done because of nonspecific abdominal symptoms and weight loss. Laparoscopic biopsy confirmed the diagnosis of mesenteric panniculitis. The primary histologic criterion is infiltration of the mesenterium by foamy lipid-laden macrophages, clusters of lymphocytes and fibrosis. The majority of cases follow a benign course and need no therapy, but co-existence of lymphoma has been reported. There have been few cases where panniculitis with progressive fibrosis changed into retractile mesenteritis with shortening of the mesenterium and compression of mesenteric vessels with partial or complete intestinal obstruction or ischemia requiring surgery. Few reported cases of severe and progressive disease have been treated with prednisone and azathioprine or cyclophosphamide.
Insights
Mesenteric panniculitis is a rare condition involving abdominal fat infiltration. While often benign, it can rarely progress to intestinal obstruction, necessitating medical or surgical intervention.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Mesenteric panniculitis is a rare, benign inflammatory condition affecting the abdominal mesentery.
- It is characterized by infiltration of the mesentery by lipid-laden macrophages, lymphocytes, and fibrosis.
Observation:
- A 70-year-old patient presented with nonspecific abdominal symptoms and weight loss.
- Ultrasound revealed a large mass at the mesentery root, leading to a laparoscopic biopsy.
- Biopsy confirmed mesenteric panniculitis.
Findings:
- The primary histological features include foamy macrophages, lymphocytes, and fibrosis within the mesentery.
- While most cases are benign, there's a reported association with lymphoma.
- Rarely, progressive fibrosis can lead to retractile mesenteritis, causing intestinal obstruction or ischemia.
Implications:
- Most cases require no specific therapy.
- Severe or progressive disease may be treated with immunosuppressants like prednisone, azathioprine, or cyclophosphamide.
- Surgical intervention may be necessary for complications such as intestinal obstruction or ischemia.