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Abstract
Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16–3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.
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Fig. 1.
Initial abdominal CT (A) and MRI (B) images show a 4.7 cm conglomerated mesenteric mass with enhancement at periumbilical area (arrows). CT, computed tomography; MRI, magnetic resonance imaging.
Fig. 2.
Gross finding of laparoscopic excisional biopsy of the mesenteric mass. The submitted specimen was a piece of irregular fibroadipose tissue measuring 1.2×0.9×0.5 cm in size.
Fig. 3.
Histopathologic findings of sclerosing mesenteritis. (A) Diffuse fibrosclerosis with infiltrate of inflammatory cells and dystrophic calcification (H&E, ×40). (B) A moderate infiltrate of chronic inflammatory cells with collagen deposition (H&E, ×200). (C) The inflammatory infiltrate was abundant plasma cells and lymphocytes in marked fibrosclerosis (left upper corner) (H&E, ×400). (D) Obliterative phlebitis: in high power view of histologic findings, there are foci of a heavy infiltrate of perivenular and intravascular inflammatory cells with obliteration of vascular lumen (H&E, ×400).
Fig. 4.
Immunohistochemical staining shows markedly increased IgG-positive plasma cells (A, ×400) and complete IgG4 negativity (B,×400). Ig, immunoglobulin.
Fig. 5.
Abdominal computed tomography of axial (A) and coronal (B) images after six months of follow-up show no specific change in size or nature of the mass lesion (arrows).
Table 1.
Reported Cases of Sclerosing Mesenteritis in Korea
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