Sclerosing Mesenteritis, a Rare Cause of Mesenteric Mass in a Young Adult: A Case Report

Eliana Piombino,Claudia Caltavuturo,Maria Carolina Picardo,Costanza D'Agata,Cristina Colarossi,Gaetano Magro,Lorenzo Memeo

doi:10.3389/fsurg.2021.722312

Abstract

Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific.

Highlights

Sclerosing mesenteritis (SM) has an insidious clinical presentation with non-specific symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss [5,6,7,8]
Coulier proposed criteria for diagnosing SM: a mesenteric mass [1] causing a mass effect without invasion of surrounding structures, [2] high attenuation [250–270 Hounse field units (HU) vs. 2,100–2,120 HU for subcutaneous fat], [3] mesenteric fat containing small (10 mm) soft tissue nodes with [4] hypo-attenuating fat surrounding the lymph nodes or mesenteric vessels (“fat halo sign”) and [5] an over-attenuating pseudocapsule surrounding the absence of ascites or known neoplasm involving the mesentery [21]
For patients non-surgically treated, some authors have reported an improvement in inflammatory markers such as ESR and c-reactive protein (CRP) with successful treatment; this is not universal and these markers may not even be elevated on presentation [1], while monitoring of surgically treated patients is usually limited to periodic CT scans [1]

Summary

INTRODUCTION

Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine [1, 2]. The etiopathogenesis is still to be elucidated and is based on the single cases reported in the literature, an association with abdominal trauma, surgery, autoimmune conditions such as IgG4 disease, infection, ischemia, and malignancy have been suggested [2,3,4,5]. A hemorrhagic and gelatinous nodular tumor mass of the mesentery, measuring 8.5 cm in its greatest dimension, was identified. It was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were evident. After 10 months of follow-up, the patient was in good condition and CT scan was negative

DISCUSSION

CONCLUSIONS

ETHICS STATEMENT