Neoplastic Mimics of the Serosa and Mesentery of the Gastrointestinal Tract

Arief A. Suriawinata and Hongfa Zhu

Sclerosing or retractile mesenteritis is an idiopatic inflammatory fibrosing process of the mesenteric adipose tissue (380,381). Mesenteric panniculitis and mesenteric lipodystrophy are other terms that are often used to reflect the predominant component of the inflammation or fat necrosis in this fibroinflammatory process (382,383).

Sclerosing mesenteritis occurs most often in middle-aged or older adults, predominantly males. It is associated with previous abdominal surgery and other inflammatory disorders. The association of sclerosing mesenteritis with IgG4-related diseases remains unclear as a small percentage of sclerosing mesenteritis may have significant IgG4-positive plasmacellular infiltrate (384,385). The most common site of involvement is the small bowel mesentery, but rare cases have been reported to involve the large bowel (386,387). The presenting symptoms are abdominal pain, weight loss, fever, and bowel obstruction (388,389). Protein-losing enteropathy as the result of disturbed lymphatic drainage caused by the sclerosed mesentery has been reported as the first manifestation of sclerosing mesenteritis (390). In addition, lymphatic blockage by the fibroinflammatory process can cause multiple mesenteric lymphatic cysts (391). Although the imaging features can be nonspecific, the “fat ring” sign and the presence of a tumoral pseudocapsule have been suggested for the diagnosis of the disease (392).

Sclerosing mesenteritis can regress spontaneously but can also have a prolonged debilitating course with a fatal outcome. The process can be extensive involving multiple organs and major vessels and, therefore, unresectable. Symptomatic patients with unresectable lesion may benefit from steroid or immunosuppressive therapy (393).