Table of ContentsDefinition / general | Essential features | Terminology | Epidemiology | Sites | Etiology | Clinical features | Radiology description | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1
Cite this page: Gonzalez RS. Sclerosing mesenteritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonsclerosingmes.html. Accessed April 19th, 2021.
Definition / general
- Uncommon nonneoplastic condition that causes thickening and shortening of colonic mesentery (JBR-BTR 2011;94:241)
- Benign fibrotic / inflammatory condition involving the mesentery
- Some cases are IgG4 related
- Older terms include idiopathic retractile mesenteritis, mesenteric panniculitis and mesentery lipodystrophy (Am J Surg Pathol 1997;21:392)
- Affects the mesentery; small bowel mesentery is involved more often than colonic
- Usually idiopathic but some cases likely a form of IgG4 sclerosing disease (J Clin Pathol 2008;61:1093)
- 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)
- Mesentery can show fat attenuation or a fibrofatty mass
- Various medications (including corticosteroids) and surgery, depending on clinical severity (Int Arch Med 2011;4:17)
- Markedly thickened and rubbery mesentery causing bowel twisting
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
Contributed by Raul S. Gonzalez, M.D.
Images hosted on other servers:
- IgG4 (in some cases)
- Nuclear beta catenin staining not present
Sample pathology report
- Transverse colon and mesentery, excision:
- Prominent bland fibrotic process involving mesentery (see comment)
- Segment of colon with reactive change.
- Negative for malignancy.
- Margins of resection unremarkable.
- Comment: The overall findings are most consistent with sclerosing mesenteritis.
- Positive for nuclear beta catenin
- Idiopathic retroperitoneal fibrosis:
- Located in retroperitoneum, not mesentery
- Inflammatory myofibroblastic tumor:
- Spindle cells more prominent
- May be positive for ALK1
- Atypical cells visible (Chirurg 2001;72:742)
- Sclerosing lymphoma:
- Inflammatory infiltrate more prominent
Board review style question #1