Mass In Mesentery Research Articles

Sclerosing mesenteritis.

A patient with light chain multiple myeloma and no evidence of disease following autologous bone marrow transplantation, developed asymptomatic mass in the right lower quadrant mesentery, which increased in size and showed FDG uptake on PET CT. The only other change of note on imaging was chronic appendicitis, confirmed on surgery and pathology. Suspecting a neoplastic mass in the mesentery, surgical resection was undertaken but the pathology revealed sclerosing mesenteritis. This rare, non-neoplastic fibro-inflammatory disease, its protean manifestations, disease associations, and treatment are briefly discussed, including the perplexing coexistence with adjacent appendicitis.

Cystic lymphangioma of the jejunal mesentery in a young adult: a rare case report

Lymphangioma is an uncommon congenital malformation of the lymphatic system that manifest as a benign tumor. They are most commonly seen in children and rarely in adults. Lymphangiomas in the peritoneal cavity are extremely rare in adults, comprising of less than 1% of all lymphangiomas. We report a case of 18-year-old healthy female who was diagnosed with cystic mesenteric lymphangioma of the small intestine on CT scan as a part of her routine health check-up. CT scan reported a large well-defined cystic mass in mesentery of the small intestine filled with a hyper dense fluid. The lesion had thin capsule and internal septa. Radiological diagnosis was confirmed intra-operatively on laparoscopy. The patient underwent laparotomy with resection of the cyst and the involved jejunum segment followed by end to end anastomosis. The specimen was sent for histo-pathological examination and the findings were consistent with the diagnosis of cystic lymphangioma of the jejunal mesentery. Cystic mesenteric lymphangiomas are rare entities in a clinical setting that can be easily missed on clinical examination or may present as asymptomatic disease. CT scan is the gold standard investigation for diagnosis of mesenteric lymphangiomas. The preferred surgical approach depends on the location of the lesion, the clinical features and the spread of the lesion to surrounding structures.

Anaplastic transformation of thyroid cancer in mesentery metastases presenting as intestinal perforation: a case report

BackgroundAnaplastic thyroid carcinoma is a highly aggressive form of thyroid cancer associated with a very poor prognosis. Anaplastic transformation most commonly occurs in the thyroid itself or within regional lymph nodes. Here we report the case of a patient with papillary thyroid cancer, presenting with colon perforation as a result of anaplastic transformation of metastases in the mesentery tissue. There have been no previous reports of this form of anaplastic transformation.Case presentationA 74-year-old man was admitted to our hospital, presenting with abdominal pain that he had been experiencing for 1 week prior to admission. The patient had a history of papillary thyroid carcinoma, for which he underwent a total thyroidectomy and mediastinal lymph node dissection 6 years earlier, and subsequently received radioactive iodine therapy for postoperative recurrence in the lung 2 years later. During the present reported admission, a computed tomography scan revealed a large intra-abdominal mass infiltrating into the colon and retroperitoneum and also highlighted the pneumoperitoneum. The patient was diagnosed with generalized peritonitis as a result of colon perforation, as such, we conducted an emergency laparotomy. Intraoperative findings showed a mass affecting the ascending colon and kidney, following which, an ileostomy and biopsy were completed. Poorly differentiated spindle cells were identified in the biopsy specimens, and histopathological and immunohistochemical findings revealed the absence of thyroid carcinoma cells. The tumor was therefore believed to be a primary sarcoma. Following surgery, the patient recovered from sepsis that had arisen as a result of colon perforation, however, rapidly developed systemic metastases and died 1 month post-operation. An autopsy was performed, and the patient was diagnosed with anaplastic papillary thyroid cancer at the mesentery site of metastasis. This conclusion was reached owing to the presence of the squamous differentiation of lymph node cells, and because tumor cells were positive results for paired-box gene 8 expressions.ConclusionsAnaplastic transformation of papillary thyroid carcinoma should be considered in the diagnosis of a large mesentery mass in patients with a history of papillary carcinoma. An appropriate biopsy and paired-box gene 8 immunostaining can be useful in confirming such a diagnosis.

Osificación heterotópica mesentérica precoz posabdomen abierto y su manejo quirúrgico. Presentación de un caso

Objective : Report the case of a patient with a history of multiple surgeries due to peritonitis and open abdomen, with intraoperative finding of mesenetrioc heterotopic ossification. Clinical case : A 59-year-old male patient with a history of complicated appendectomy 12 months ago, which requires the management of an open abdomen, right colectomy and terminal ileostomy. One year after appendectomy, is readmitted for transit reconstitution. Intraoperative finding were calcified mass in mesentery, of 15 x 10 x 6 cm, whose histological study reports mesenteric heterotopic ossification. This entity has low frequency, and is associated with a history of trauma and abdominal surgery, is described as a cause of morbidity and mortality. Resective surgical management is feasible for experienced teams. Conclusion : A case with antecedent of open abdomen is described, with later finding of mesenteric heterotopic ossification. This clinical case is representative for its classic risk factors and management used for its resolution.

Molecular Testing for EGFR Mutations and ALK Rearrangements in the Cytological Specimens From the Patients With Non-Small Cell Lung Cancer.

The aim of this study was to investigate epidermal growth factor receptor (EGFR) gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements using cytological specimens from the patients with a diagnosis of primary or metastatic lung non-small cell carcinoma. A total 307 cases were submitted for EGFR mutational analysis and 265 cases for ALK analysis. The cytological specimen sources included lung, lymph node, liver, bone, adrenal gland, mesentery mass, and body fluids/bronchial brushing. EGFR mutations in the exons 18 to 21 were analyzed with Qiagen EGFR Pyro Kits. Fluorescence in situ hybridization (FISH) studies for ALK rearrangement inv(2)(p21; p23) were performed on the paraffin-embedded cell block sections utilizing dual-color Vysis LSI ALK Break Apart Probe Kit. Among 307 fine needle aspirate cases for EGFR analysis, 302 cases (269 from cell blocks, 33 from direct smears) had sufficient material for EGFR test. Five cases failed due to inadequate cellularity. Twenty six of 302 (8.6%) cases were positive for EGFR mutations. A total of 265 cases submitted for ALK analysis included 240 cases of fine needle aspirate, 25 cases of pleural fluid/pericardial fluid/bronchial washings. Eight cases failed because of low cellularity, whereas 257 of 265 cases had sufficient material for ALK FISH study. Nine of 257 cases (3.5%) revealed ALK rearrangement by FISH. The current study demonstrates that cytological specimens can yield sufficient material for EGFR mutations and ALK rearrangement test. Our study reveals that 8.6% of EGFR mutation rate and 3.5% of ALK rearrangement rate in the cytology specimens from the patients with primary or metastatic lung non-small cell carcinoma.

A rare case of mesenteric intranodal schwannoma

Intranodal schwannomas are an extremely rare pathology with broad differential diagnoses of benign and malignant spindle cell lesions. This case reports a 71-year-old female who presented with abdominal discomfort and was found to have a 6 cm small bowel mesentery mass. The patient proceeded to have the mass laparoscopically resected. Histological examination revealed an encapsulated lesion composed of spindle cells with remnant lymph node architecture at the peripheries. These findings proposed a broad list of differential diagnoses, including metastatic melanoma, GIST, spindle cell carcinomas, spindle cell sarcomas, myofibroblastoma and leiomyoma. Immunohistochemistry revealed the lesion was positive for neural markers S100 and Sox10, and negative for cytokeratins, melanoma markers and GIST markers, favouring the diagnosis of an intranodal schwannoma. A literature review found only six other cases of intranodal schwannoma. These cases described similar morphology but exhibited great variability in the reported immunohistochemical analysis. This rare case demonstrates the importance of considering broad differential diagnoses in cases of intranodal spindle cell lesions and the use of immunohistochemical methods to exclude more sinister pathologies.

Renal cell carcinoma with isolated metastasis to sigmoid mesentery: a rare resectable combination

Renal cell carcinoma accounts for 2%–3% of all malignancies in adults. It spreads via direct extension, lymphatic route as well as haematogenous route. Lymph nodes, lungs, bone, liver and brain...

GIST or Not - A Unique Case of Low Grade Endometrial Stromal Sarcoma with Review of Literature

Endometrial stromal sarcoma (ESS) is a mesenchymal neoplasm that usually occurs as a primary tumor of the uterine corpus, but rarely arises in other sites, such as the ovary, pelvic cavity, mesentery, omentum and intestine. Endometrial stromal sarcoma is a malignant subtype of endometrial stromal tumor arising from the stroma (connective tissue) of the endometrium rather than the glands. There are three grades for endometrial stromal tumors. All the cases yet reported in literature had a history of previous hysterectomy with or without a diagnosis of ESS. Here we present a unique case of Low grade ESS where the patient presented with vague abdominal pain, loss of weight and anemia. On evaluation with USG and CT demonstrated a lobulated mass in mesentery which led to the diagnosis of a GIST from small bowel. Intraoperatively the lesion was in omentum with no attachment to mesentery. The enlarged uterus with fibroids were also removed along with the omental mass after a clinicopathological discussion which suggested the possibility of ESS with primary in the uterus. The histopathology demonstrated Low grade Endometrial sarcoma which was supported by immunohistochemistry

Idiopathic Sclerosing Mesenteritis: Uncommon Cause of Abdominal Pain

Purpose: Idiopathic sclerosing mesenteritis is a disease of the small intestine, characterized by chronic inflammation and eventual fibrosis of the mesentery. Methods: A 79-year-old female was admitted for recurrent episodic dizziness, nausea with vomiting and abdominal pain. The patient was treated for vertigo six weeks ago in the ER and had head CT, which was essentially normal. She had been feeling fine between episodes. PMHx was significant for hypothyroid and hypertension. No prior history of surgery or trauma to the abdomen. The patient was on lisinopril and synthroid. Initial labs were unremarkable. CT abdomen showed a prominently calcified mass in mesentery, with tethering of small bowel loops. Twenty-four-hour urine for 5-HIAA for carcinoid syndrome, ESR and CRP were normal. Upper endoscopy and colonoscopy were unremarkable. Gynecologic evaluation was unremarkable. Results: Patient went for laparoscopic segmental resection of 11.5 cm of small bowel and mass to exclude malignancy. Pathology showed a segment of unremarkable small bowel and attached mesentery. Within the mesentery, there was an ill-defined area characterized by patchy mild chronic inflammation, numerous foamy histiocytes and broad, irregular bands of sclerosing collagenous tissue. Marked dystrophic calcification was present as well. The histologic features were those of sclerosing mesenteritis. Immunohistochemistry staining for IgG4, cytokeratin and B-cell lymphoma, including SLL and mantle cell lymphoma, were negative. Conclusion: The epidemiology is unknown, as the disease is rare. Most reports have found a male preponderance. Pathogenesis includes previous abdominal surgery or trauma, autoimmunity, paraneoplastic syndrome, ischemic injury and infection. The most common clinical presenting symptom is abdominal pain, but 50% of patients can have an abdominal mass typically in the left upper quadrant or epigastrium. The erythrocyte sedimentation rate and C-reactive protein level may be elevated and serve as surrogate markers of a therapeutic response to medical therapy. Abdominal imaging is an essential component of the diagnostic evaluation, but the diagnosis is established by histologic evaluation. In patients who are symptomatic, tamoxifen, azathioprine or cyclophosphamide may be used for stabilization of symptoms, and thalidomide can be considered for refractory cases. Surgery is best reserved for obstructive complications and to exclude malignancy.

Inadvertently Discovered Round Mass in Mesentery

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

Letter to the Editor

September 2007 Dear Editor, PRIMARY ILEAL MESENTERIC HYDATIDOSIS: A RARE CAUSE OF COLICKY ABOMINAL PAIN IN CHILDHOOD A 3-year old boy from a rural village in western India presented with intermittent pain in his abdomen for a duration of 15 days, associated with weight loss of around 6 kg over 3 months, which his mother put down to loss of appetite. His family ran a cattle farm and had intimate contact with goat and sheep. There was no history of hydatid disease in other members of the family who all lived under one roof. On examination, he had mild tenderness in the right hypochondrium and a vague, irregular, mobile, palpable mass, but no abdominal distension or visible peristalsis. Full blood count, alanine transaminase, alkaline phosphate, aspartate transaminase, gamma glutamyl transpeptidase, bilirubin and blood glucose were normal. An abdominal ultrasound showed multiple cystic areas in the central abdomen, with cysts measuring 2 mm to 8 cm with multiple loculi. The liver, spleen and kidneys were normal (Fig. 1). The provisional diagnosis was mesenteric hydatid disease and the patient underwent laparotomy and resection of the affected small bowel segment. The involved ileum and mesenteric mass including all hydatid cysts were excised. The liver and other organs were free of the disease. The gross specimen, a 25 × 25 × 15 cm mesenteric cystic mass, consisted of the terminal portion of jejunum and proximal portion of ileum (Fig. 2). Histopathology showed multiple daughter cysts within larger cysts that varied in diameter from 0.4 to 8 cm. He was discharged, taking long-term cyclic treatment with albendazole (10 mg/kg daily for 8 months as per World Health Organisation recommendations). Consecutive ultrasounds over 5 years showed no recurrence. Ultrasound showing multi-cystic areas in abdomen. Intra-operative picture showing small bowel mesentery mass with multiple multi-cystic masses and daughter cysts of varying sizes. Hydatid disease in humans is caused by Echinococcus granulosus (dog tapeworm). The dog is the definitive host. Ova shed in dog faeces infect the intermediate host (e.g. cattle, sheep), making it endemic in lamb/sheep rearing countries. Human infection occurs after the ingestion of ova, which penetrate the intestinal wall, passing via the portal vein into the liver, lungs and other tissues. A hydatid cyst can develop anywhere in the body, most commonly in the liver, although <25% occur in the lungs.1,2 Immigration, travel and migration make this disease globally important. Infections affecting bone are rare but they have been reported in pathology text and articles. The patient can present with pain in the abdomen, hepatomegaly, loss of weight, failure to thrive and complications due to the rupture of a cyst into the peritoneal cavity, anaphylactic shock, eosinophilia, urticaria, implantation into other organs and viscera, jaundice and cholangitis.3 This boy's clinical presentation at such a young age was atypical. We present this case to illustrate the importance of ultrasound scan in diagnosis.