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Aim and subject. Sclerosing mesenteritis is a rare non-tumoral disease that usually affects the small intestine.Several etiological hypotheses have been proposed (external or surgical trauma, autoimmunity, neoplasia).Clinical case description and main results. We describe the autopsy case of a 66-year-old woman who presented to hospital unconscious with a palpable abdominal mass. The patient underwent abdominal CT, which revealed a mass involving the transverse colon and mesocolon with non-pathognomonic features, but with a strong suspicion of neoplasia. However, the patient died quickly, before a biopsy could be performed. The only prominent finding at autopsy was a transverse colonic wall mass associated with colic perforation and mucosal hyperplasia. Histology revealed sclerosing mesenteritis after a thorough microscopic and immunohistochemical investigation of possible differential diagnoses.Conclusions. There are three types of sclerosing mesenteritis, depending on the fibrous component, and the case described is an example of retractile mesenteritis (preponderant fibrosis). A mini-review of the Pubmed database shows that the different ways of referring to this disease make it difficult to search, but a total of 213 cases appear to be published so far. Overall, the location, clinical presentation and macroscopic findings of our case represent a true rarity.

Sclerosing mesenteritis is a rare abdominal condition characterized by chronic inflammation and the fibrosis of fat tissue, typically involving the small bowel mesentery. This article presents a case of a 62-year-old patient suffering from sclerosing mesenteritis, whose disease was complicated by perforation of his Meckel’s diverticulum. Proper diagnosis of perforation was delayed due to the presence of ascites which masked signs of peritonitis. The patient was operated on and the perforated diverticulum was resected. The post-operative course was complicated by an episode of intraabdominal bleeding, however, the patient survived. The presented case is probably the first description of a perforation of Meckel’s diverticulum in a patient suffering from sclerosing mesenteritis.

Abstract Two patient cases are presented in this case series. Both patients presented with vague abdominal pain, and CT imaging showed calcified mesenteric masses. Definitive diagnoses of sclerosing mesenteritis was made on histological evaluation. Interestingly, one of these patients was initially misdiagnosed with a neuroendocrine tumor after Octreotide scan showed increased mesenteric uptake. He underwent treatment for neuroendocrine tumor however had disease progression to small bowel obstruction, requiring emergent exploratory laparotomy with palliative resection of the mesenteric mass and involved small bowel. He experienced cardiac arrest in the immediate post-operative period and unfortunately did not survive. This case series exemplifies the importance of early diagnosis and management to prevent catastrophic complications in an otherwise benign disease.

Sclerosing mesenteritis (SM) is a rare disease with non-specific clinical manifestations and should be supported by radiological examination and confirmed by histopathological evaluation. Its relationship with cancer especially caecal adenocarcinoma is still unclear. This case report describes a young man who was diagnosed as having SM and poorly-differentiated caecal adenocarcinoma.

Purpose Sclerosing mesenteritis (SM), a fibroinflammatory process of the mesentery, can rarely occur after immune checkpoint inhibitor (ICI) therapy; however, its clinical significance and optimal management are unclear. We aimed to assess the characteristics and disease course of patients who developed SM following ICI therapy at a single tertiary cancer center. Methods We retrospectively identified 12 eligible adult cancer patients between 05/2011 and 05/2022. Patients’ clinical data were evaluated and summarized. Results The median patient age was 71.5 years. The most common cancer types were gastrointestinal, hematologic, and skin. Eight patients (67%) received anti-PD-1/L1 monotherapy, 2 (17%) received anti-CTLA-4 monotherapy, and 2 (17%) received combination therapy. SM occurred after a median duration of 8.6 months from the first ICI dose. Most patients (75%) were asymptomatic on diagnosis. Three patients (25%) reported abdominal pain, nausea, and fever and received inpatient care and corticosteroid treatment with symptom resolution. No patients experienced SM recurrence after the completion of corticosteroids. Seven patients (58%) experienced resolution of SM on imaging. Seven patients (58%) resumed ICI therapy after the diagnosis of SM. Conclusions SM represents an immune-related adverse event that may occur after initiation of ICI therapy. The clinical significance and optimal management of SM following ICI therapy remains uncertain. While most cases were asymptomatic and did not require active management or ICI termination, medical intervention was needed in select symptomatic cases. Further large-scale studies are needed to clarify the association of SM with ICI therapy.

BackgroundMesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat.ObjectivesThis study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis.Materials and methodsIn this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation.ResultsMesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis.ConclusionMesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.

This study aimed to summarize the features of IgG4-related sclerosing mesenteritis (IgG4-SM) based on both our large prospective IgG4-related disease (IgG4-RD) cohort and literature-reported IgG4-SM cases. We applied a mixed-methods approach, integrating data from 29 patients with IgG4-SM and 87 matched IgG4-RD patients without mesenteritis, all enrolled in a prospective cohort of IgG4-RD from Peking Union Medical College Hospital (PUMCH) since 2011. Additionally, we included 32 IgG4-SM cases reported in public databases since 2011. Demographic, clinical, laboratory, imaging and treatment data were systematically compared. Compared with IgG4-RD without mesenteritis, IgG4-SM predominantly affected elderly males and accompanied with more organ involvement ( = 0.019) and elevated responder index (RI) scores and Physician Global Assessment (PGA) scores ( = 0.005 and = 0.018, respectively). Compared to the literature-reported cases, IgG4-SM patients in our cohort exhibited a lower prevalence of abdominal pain ( < 0.001) but a higher frequency of submandibular gland ( < 0.001) and lacrimal gland enlargement ( < 0.001). Imaging features included a spectrum of mesenteric abnormalities, ranging from misty opacities to soft-tissue masses on computed tomography (CT), with significantly increased F-fluorodeoxyglucose ( F-FDG) uptake on positron emission tomography-computed tomography (PET-CT). Despite divergent treatments (glucocorticoids/immunosuppressants in our cohort . surgical resection in reported cases, < 0.001), long-term relapse rates were comparable ( = 0.17). IgG4-SM is a significant but under-recognized manifestation of IgG4-RD, characterized by a predilection for elderly males, multi-organ involvement, higher disease activity and distinct imaging features. Systemic radiological evaluation, including PET-CT could assist diagnosis and treatment monitoring. Glucocorticoid-based therapy achieved outcomes comparable to surgery, challenging the necessity of invasive interventions. This study expands the clinical spectrum of IgG4-SM and advocates for personalized, non-surgical management strategies in most cases.

IgG4-related disease (IgG4-RD) is a systemic, autoimmune, fibroinflammatory disease that can cause multi-organ damage. Although there have been many trials and studies since its recognition in 2003, there is still much that is unknown. Furthermore, IgG4-RD can affect any organ in the body and often has many mimics and alternative diagnoses, which can make for a challenging workup. Imaging plays a substantial role in the diagnosis of IgG4-RD and is often the first occasion where IgG4-RD comes into consideration. Thus, knowledge about the imaging findings of various manifestations of IgG4-RD can aid in the diagnosis and have a significant impact on patient management. In this article, we review the wide array of imaging findings, both typical and atypical, as well as possible mimics of IgG4-RD in the abdomen and pelvis.

Background Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory conditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical SM is not fully understood. The aims of this study were to determine whether any correlation could be found between the radiological findings and the clinical disease course. Methods Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be verified histologically or MP radiologically, the patients were included in this descriptive retro perspective study. Results Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to moderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to histologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All four had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with multiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM. Conclusions We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic changes and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the term SM should be reserved for this latter condition.

Objectives Systematic review to determine any association between imaging features of idiopathic mesenteric panniculitis (MP) and subsequent malignancy. Methods Two researchers searched primary literature independently for imaging studies of MP. They extracted data focusing on methodology for unbiased patient accrual and capability to determine a link between MP and subsequent malignancy. They noted imaging features of MP. Data were accrued and meta-analysis intended. Results Fourteen of 675 articles were eligible; 1,226 patients. Only three (21 %) accrued patients prospectively. Twelve (86 %) studies described CT features. Follow-up varied widely; 1 month to 8 years. Prevalence of MP was influenced by accrual: 0.2 % for keyword search versus 1.7 % for consecutive series. Accrual bias affected nine (64 %) studies. 458 (38 %) of 1,209 patients had malignancy at accrual but varied widely (8–89 %), preventing meta-analysis. Sixty (6.4 %) of 933 patients developed new malignancy subsequently, also varying widely (0–11 %). Of just four studies that determined the proportion of unselected, consecutive patients with MP developing subsequent malignancy, three were retrospective and the fourth excluded patients with lymphadenopathy, likely excluding patients with MP. Conclusion Studies were heterogeneous, with biased accrual. No available study can determine an association between MP and subsequent malignancy with certainty. Key Points • Our systematic review of mesenteric panniculitis found that imaging studies were biased . • Spectrum and recruitment bias was largely due to retrospective study designs . • No study could confirm a certain link between mesenteric panniculitis and subsequent malignancy . • Excessive methodological heterogeneity precluded meaningful meta-analysis . • High-quality research linking mesenteric panniculitis imaging features and subsequent malignancy is needed .