Inadvertently Discovered Round Mass in Mesentery

Abstract

Question: A 77-year-old woman was referred for an incidental finding on computed tomography (CT) during treatment of ischemic colitis. She has been taking medication for hypertension and seemed to be recovered from acute illness on referral with stable vital signs and normal laboratory findings. Total colonoscopy showed findngs suggestive of ischemic colitis. On physical examination, a tiny, nontender, rubbery, round nodule was palpable in the left upraclavicular region. Abdominopelvic CT revealed colonic wall thickening from ascending to sigmoid colon, conforming best to schemic colitis. Interestingly, a round, well-enhanced mass on small bowel mesentery measuring 3.3 3.3 cm was discovered Figure A). Positron emission tomography/CT fusion scan revealed an intense hypermetabolic mass on small bowel mesentery, as ell as in the left supraclavicular and para-aortic region. Ultrasonography-assisted fine needle aspiration on the left supraclavicular odule showed many lymphocytes and some histiocytes, but no malignancy was seen. To expedite diagnosis, laparoscopic excision as performed; the mass was round with a cut surface admixed of yellowish and bloody material (Figure B). What is the likely diagnosis? Look on page 1128 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information n submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest: The authors disclose no conflicts. © 2011 by the AGA Institute 0016-5085/$36.00 doi:10.1053/j.gastro.2010.06.079