Sclerosing Mesenteritis as a Cause of Abdominal Mass and Discomfort in an Elderly Patient: A Case Report and Literature Review

Sclerosing mesenteritis is a rare benign process that involves inflammation, fat necrosis, and fibrosis of the mesentery. The disease poses great diagnostic challenge due to its nonspecific clinical and diagnostic findings. We report the case of a 75-year-old man who presented with vague abdominal discomfort associated with an intra-abdominal mass. With suspicion of a bowel carcinoid tumor on computed tomography scans, the patient underwent diagnostic laparoscopy. A diagnosis of sclerosing mesenteritis was made on histological examination. The patient's symptoms responded to a combination of immunosuppressive drugs, with no interval change in the size of the mass on radiological examination after fifteen months.

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Imaging Features of Renal Capsule Leiomyoma on Contrast-Enhanced Ultrasonography: A Case Report

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479317705838 ◽

2017 ◽

Vol 33 (6) ◽

pp. 514-519 ◽

Cited By ~ 1

Author(s):

José Andrade Moura Neto ◽

Ana Flavia Perpétuo de Souza ◽

José Hermógenes Rocco Suassuna ◽

Luiz Carlos Aguiar Vaz ◽

Nordeval Cavalcante Araújo

Keyword(s):

Transplant Recipient ◽

Kidney Transplant Recipient ◽

Malignant Lesion ◽

Immunosuppressive Drugs ◽

Imaging Features ◽

Diagnostic Challenge ◽

Contrast Enhanced ◽

Increased Risk ◽

Contrast Enhanced Ultrasonography ◽

Histopathologic Analysis

Leiomyomas of the kidney are rare, mostly occurring in adults as incidental findings, and are a diagnostic challenge. In a renal transplant recipient population, an increased risk of tumors is observed due to the effect of immunosuppressive drugs. A differential diagnosis between leiomyomas and other malignant lesions is not possible with current imaging methods. This report presents a case of a native kidney capsular leiomyoma in a kidney transplant recipient and highlights the features of computed tomography and contrast-enhanced ultrasound (CEUS), along with the histopathologic analysis. The CEUS and quantification studies are helpful in demonstrating the vascularization pattern of the renal capsular leiomyoma. This entity appearing with chronic kidney disease can resemble a renal cell carcinoma, in an otherwise healthy kidney. In this case, CEUS was useful for diagnosing the vascularization of the renal mass, although the pattern of intense vascularization could be diagnostically misleading, implying a malignant lesion. However, the pattern of enhancement due to CEUS showed no peculiarities that indicated histopathologic diagnosis.

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Sclerosing mesenteritis - rare cause of abdominal pain and intra-abdominal mass: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20150843 ◽

2015 ◽

pp. 2863-2866

Author(s):

Atul Yadgire ◽

Saurabh Tiwari ◽

Narayan Umale

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Abdominal Mass ◽

Sclerosing Mesenteritis

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A Case of Sclerosing Mesenteritis during Etanercept Therapy for Psoriatic Arthritis

Case Reports in Rheumatology ◽

10.1155/2020/8899658 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Aleksandra Bukiej

Keyword(s):

Acute Kidney Injury ◽

Psoriatic Arthritis ◽

Kidney Injury ◽

Abdominal Discomfort ◽

Sclerosing Mesenteritis ◽

Ureteric Obstruction ◽

Retroperitoneal Mass ◽

Etanercept Therapy ◽

First Case ◽

One Year

Sclerosing mesenteritis (SM) is a chronic nonspecific mesenteric inflammation. I report a case of a 72-year-old male treated with etanercept for psoriatic arthritis for 7 years who developed abdominal discomfort, urinary retention, acute kidney injury, and bilateral ureteric obstruction. CT abdomen revealed retroperitoneal mass. Biopsy showed sclerosing mesenteritis. One year later, after discontinuation of etanercept, CT abdomen showed regression of the mass. To my knowledge, this is first case report of reversible sclerosing mesenteritis associated with etanercept therapy.

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Sclerosing mesenteritis presenting as an abdominal mass

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2000.03054.x ◽

2000 ◽

Vol 95 (9) ◽

pp. 2612-2612

Author(s):

Andrzej Ukleja ◽

Stephen Lange M ◽

Sami Achem R

Keyword(s):

Abdominal Mass ◽

Sclerosing Mesenteritis

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Are tumefactive lesions classified as sclerosing mesenteritis a subset of IgG4-related sclerosing disorders?

Journal of Clinical Pathology ◽

10.1136/jcp.2008.057869 ◽

2008 ◽

Vol 61 (10) ◽

pp. 1093-1097 ◽

Cited By ~ 66

Author(s):

T S Chen ◽

E A Montgomery

Keyword(s):

High Power ◽

Autoimmune Pancreatitis ◽

Plasma Cells ◽

Relative Proportion ◽

Sclerosing Mesenteritis ◽

Fat Necrosis ◽

Lymphoplasmacytic Sclerosing Pancreatitis ◽

Reactive Plasma ◽

Sclerosing Pancreatitis ◽

The Relationship

Background:The relationship between tumefactive lesions classified as sclerosing mesenteritis and IgG4-related sclerosing disorders (eg, lymphoplasmacytic sclerosing pancreatitis/autoimmune pancreatitis) remains uncertain.Aims:To review lesions coded as “sclerosing mesenteritis” for findings in keeping with IgG4-related sclerosing disorders.Methods:Inclusion in the study required available paraffin blocks for IgG4 staining and documentation of a mass lesion.Results:A total of nine mesenteric lesions (3–14 cm) were identified in 6 male and 3 female patients. On H&E-stained sections, all were characterised as loosely marginated fibroinflammatory processes with variable amounts of fat necrosis. Lymphocytic venulitis/phlebitis was identified in 8 of 9 cases. IgG and IgG4 expression in lesional plasma cells was assessed by immunohistochemistry. IgG4-positive plasma cells were counted in the areas of greatest density in ⩾3 high power fields (HPFs). The highest number per HPF was recorded and a score assigned based on the following scale: <5/HPF, none/minimal; 5–10/HPF, mild; 11–30/HPF, moderate; >30/HPF, marked. The relative proportion of IgG4-reactive plasma cells to total IgG-positive plasma cells was assessed. IgG4-reactive plasma cells ranged from 0 to >100 in the most dense zones (3 cases, none/minimal; 4 cases, moderate; 2 cases, marked).Conclusions:Although this study is limited by small numbers, findings suggest that some tumefactive lesions regarded as sclerosing mesenteritis may be a subset of IgG4-related sclerosing disorders.

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A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures

Case Reports in Otolaryngology ◽

10.1155/2016/6019501 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Albert Y. Han ◽

Jacob F. Lentz ◽

Edward C. Kuan ◽

Hiwot H. Araya ◽

Mohammad Kamgar

Keyword(s):

Lymph Node ◽

Internal Jugular Vein ◽

Contraceptive Use ◽

Jugular Vein ◽

Diagnostic Testing ◽

Cervical Lymphadenopathy ◽

Neck Mass ◽

Fat Necrosis ◽

Diagnostic Challenge ◽

Jugular Vein Thrombosis

A tender neck mass in adults can be a diagnostic challenge due to a wide differential diagnosis, which ranges from reactive lymphadenopathy to malignancy. In this report, we describe a case of a young female with an unusually large and tender reactive lymph node with fat necrosis. The diagnostic imaging findings alone mimicked that of scrofula and malignancy, which prompted a complete workup. Additionally, the enlarged lymph node was compressing the internal jugular vein in the setting of oral contraceptive use by the patient, raising concern for Lemierre’s syndrome or internal jugular vein thrombosis. This report shows how, in the appropriate clinical context, and especially with the involvement of adjacent respiratory or neurovascular structures, aggressive diagnostic testing can be indicated.

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Left Lateral and Left Middle Liver Lobe Torsion in a Saint Bernard Puppy

Journal of the American Animal Hospital Association ◽

10.5326/0420381 ◽

2006 ◽

Vol 42 (5) ◽

pp. 381-385 ◽

Cited By ~ 11

Author(s):

Dirsko J.F. von Pfeil ◽

L. Ari Jutkowitz ◽

Joe Hauptman

Keyword(s):

Differential Diagnosis ◽

Early Diagnosis ◽

Surgical Intervention ◽

Abdominal Mass ◽

Rare Condition ◽

Abdominal Discomfort ◽

Liver Lobe ◽

Saint Bernard ◽

Left Middle ◽

Exploratory Surgery

A 5-month-old, male Saint Bernard was presented for acute collapse and abdominal discomfort. Significant findings were a cranial abdominal mass, hemorrhagic abdominal effusion, anemia, and disseminated intravascular coagulation. An exploratory surgery revealed torsion of both the left lateral and middle liver lobes, a condition that has not been previously described in the veterinary literature. Torsion of one or more hepatic lobes is a rare condition but should be considered as a differential diagnosis for acute abdomen syndrome in both young and mature dogs. Early diagnosis and prompt surgical intervention may be curative.

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