Sclerosing mesenteritis

Colon tumor
Mesenchymal tumors
Sclerosing mesenteritis

Author: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 4 January 2017, last major update December 2016

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed search: sclerosing mesenteritis colon

Table of Contents

Cite this page: Sclerosing mesenteritis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colontumorsclerosingmes.html. Accessed July 14th, 2017.

Definition / general

Uncommon nonneoplastic condition that causes thickening and shortening of colonic mesentery (JBR-BTR 2011;94:241)

Essential features

Benign fibrotic / inflammatory condition involving the mesentery
Some cases are IgG4 related

Terminology

Older terms include idiopathic retractile mesenteritis, mesenteric panniculitis and mesentery lipodystrophy (Am J Surg Pathol 1997;21:392)

Epidemiology

Common in rural areas of Peru (Rev Gastroenterol Peru 1998;18 Suppl 1:114), otherwise fairly uncommon
Possibly underdiagnosed in life, as indicated by one autopsy series (Schweiz Med Wochenschr 1985;115:1218)

Sites

Affects the mesentery; small bowel mesentery is involved more often than colonic

Etiology

Usually idiopathic, but some cases likely a form of IgG4 sclerosing disease (J Clin Pathol 2008;61:1093)

Clinical features

Usually men with median age of 65 years; most common symptom is abdominal pain; can lead to patient death (Clin Gastroenterol Hepatol 2007;5:589)

Radiology description

Mesentery can show fat attenuation or a fibrofatty mass

Case reports

40 year old man with large mesenteric mass (Arch Pathol Lab Med 2001;125:443)
46 year old woman with rectosigmoid disease (Surg Today 1996;26:435)

Treatment

Various medications (including corticosteroids) and surgery, depending on clinical severity (Int Arch Med 2011;4:17)

Clinical images

Images hosted on other servers:

Thick mesentery with yellow nodules

Gross description

Markedly thickened and rubbery mesentery causing bowel twisting

Gross images

Images hosted on other servers:

Distorting bowel loops

Microscopic (histologic) description

Fibrosis with dense collagen, fat necrosis, chronic inflammation (especially around vessels) and variable focal calcification
Minimal atypia, no or few mitoses
IgG4 related cases lack fat necrosis and show obliterative phlebitis and increased inflammation

Microscopic (histologic) images

Images hosted on PathOut server:

Courtesy of Raul S. Gonzalez, M.D.