Sarrath Sutthipong, MD, Chumpunut Chuthanan, MD, Chinnavat Sutthivana, MD, Petch Kasetsuwan, MD. Bhumibol Adulyadej Hospital, Bangkok, Thailand
Background: Mesenteric panniculitis (MP) is a rare, benign and chronic fibrosing inflammatory disease that affects the adipose tissue of the mesentery of the small bowel and colon. The specific etiology is unknown and no clear information about the incidence. The diagnosis is suggested by CT and is usually confirmed by surgical biopsy. Treatment is based on some selected drugs. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. We reported a case of the MP diagnosed with CT and surgical biopsy by laparoscopic approach.
Case report: 50-year-old woman with 5 months history of chronic abdominal pain, mainly localized in the sub-epigastrium, intermittent and mild. She had anorexia but no weight loss or change in bowel habits. No history of medical illness or surgery. The physical examination was unremarkable, except for palpation of ill-defined mass about 5 cm at mid-abdomen, firm, smooth surface with mild tenderness. The laboratory profile and tumor marker were normal. CT of the abdomen, which showed focal heterogeneous enhancement of the mesenteric fat with stranding (8.7×4.8×10 cm) with multiple internal subcentimeter LNs in the supra-umbilical area, which was probably inflammatory in origin and suggestive of MP. 18F-FDG PET/CT showed faint FDG uptake in multiple mesenteric LNs. The patient was subsequently underwent diagnostic laparoscopy with biopsy. Intra-operative finding showed a fat-like surface of yellowish mass at mesentery of jejunal segment, incisional biopsy was performed laparoscopically. The histology showed adipose tissue with areas of fat necrosis, fibrosis, foamy macrophages infiltration and predominant chronic inflammation, no evidence of malignancy. IHC studies (including CD68, S-100, CD3 and CD20) were performed and the result was compatible with reactive process. Treatment was started with 40 mg prednisone once daily and planned for follow-up with repeated CT scan.
Discussion: MP involves the small bowel mesentery in over 90% of cases. The diagnosis is made by 3 pathologic findings: fibrosis, chronic inflammation and fatty infiltration. The differential diagnosis is broad and has been associated with malignancies such as lymphoma, well-differentiated liposarcoma and melanoma. The imaging appearance varies depending on the predominant tissue component. A definitive diagnosis is biopsy but open biopsy is not always necessary. No data of laparoscopic biopsy, which has been reported previously. Treatment has been reserved for symptomatic cases with a variety of drugs. Our case was started on oral corticosteroid treatment and waited for responsive evaluation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87311
Program Number: P141
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster