A Study of Patients With a Radiologic Diagnosis of Mesenteric Panniculitis and the Correlation With Malignancy

Abstract

Introduction: Mesenteric panniculitis (MP), a “misty” or “hazy” mesentery and/or an unexplained mesenteric mass is an uncommon finding on computerized tomographic (CT) scanning. This finding in patients with prior cancer has been described, but its significance is poorly understood. We reviewed its association with malignancy, disease natural history; additional and follow-up imaging studies in a large group of patients with mesenteric abnormalities and either known history of cancer, or those with newly diagnosed cancers. Methods: CT scans showing “mesenteric panniculitis” or “misty mesentery” in patients with known or newly diagnosed cancer at North Shore University Health System were identified from January 2005-April 2010. Medical records were reviewed. Results of positron emission tomography (PET) were noted. In total, 359 patients (from 147,794 CT scans) had MP-like abnormalities. Of these patients, 81 had a known history of cancer and 19 had a new diagnosis of cancer. Results: Lymphomas were the most common cancers associated with MP (36%), with follicular lymphoma being the most common subtype (17/36), (Table 1). A variety of solid tumors were found, the most common being prostate (7) and renal cell cancer (6). CT follow-up was obtained in 71 patients. The CT was unchanged in 62, worsened in 7, and improved in 2 patients. PET scans were performed in 44 patients. Positive uptake in mesenteric lymph nodes was seen in 13 patients (29.6%). Positive uptake in the mesenteric mass was only seen in 2 patients (4.5%). Follow-up PET scanning showed no uptake in the mesenteric mass in both of these patients.Table 1Conclusion: Mesenteric changes suggestive of mesenteric panniculitis are seen in association with a variety of cancers. These changes generally remain stable on follow-up CT. Mesenteric uptake of fludeoxyglucose (FDG) during PET scanning does not occur in these lesions.