Medicine

JOBNAME: No Job Name PAGE: 1 SESS: 6 OUTPUT: Fri Mar 18 16:13:08 2011 /v2501/blackwell/A_journals/ans_v0_i0_new/ans_5714

LETTERS TO THE EDITOR
ANZJSurg.com
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Dear Editor, Mesenteric panniculitis masquerading as a mesenteric neoplasm: a rare presentation
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Mesenteric panniculitis is a rare non-neoplastic inflammatory condition of the mesentery affecting adults.1,2 It can result in the development of large masses in the abdomen, which can mimic a tumour. A 62-year-old male presented with acute abdominal pain. Imaging studies showed features of small bowel obstruction with two nodular masses in the abdomen extending from the mesenteric root. With the clinical diagnosis of tumour arising in the wall of intestine, the patient underwent surgical debulking. Grossly, two nodular lesions measuring 4 cm and 2.5 cm in the mesenteric root (Fig. 1a). Cut surface of both the nodules was yellowish brown and firm (Fig. 1b). Microscopically, the nodules showed fibro-adipose tissue with widespread fat necrosis (Fig. 1c). Interspersed within the fibrosed areas were chronic inflammatory cells (Fig. 1d). The patient had an uneventful recovery after surgery and his symptoms subsided completely.

The clinical presentation of mesenteric panniculitis is variable. It can present as a palpable abdominal mass. Grossly, diffuse thickening of the base of mesentery, or a single mass more distally in the mesentery, or multiple masses throughout the mesentery can be seen.3 Differential diagnosis on laparoscopy must include more frequently encountered mesenteric masses such as lymphomas and carcinoid tumours. The pathologic differential diagnosis in the established stage of the disease includes fibrosis and chronic inflammation secondary to foreign material, infections or malignancies. Trauma, drugs, autoimmune disorders, infection, vascular have been postulated in the pathogenesis.4 Prognosis is excellent. Proper treatment...