SUNY Upstate Medical University Syracuse, NY, United States
Fathima K. Suhail, MD1, Abdul Bhutta, MD1, Bishnu Sapkota, MD, FACG2 1SUNY Upstate Medical University, Syracuse, NY; 2Syracuse VA Medical Center, Syracuse, NY
Introduction: Sclerosing mesenteritis is a rare, non-neoplastic, inflammatory and fibrotic disease affecting the mesentery. Most patients are asymptomatic, and the prevalence is reported to be 1%. The etiology is unclear but include surgery, trauma, autoimmunity, ischemia and paraneoplastic syndrome. We present a case of sclerosing mesenteritis leading to a diagnosis follicular lymphoma.
Case Description/Methods: A 60-year-old male with hypertension presented with acute left lower quadrant pain. The pain was constant, dull, non-radiating and without exacerbating or relieving factors. He reported night sweats and 30-pound weight loss over one year. He denied fevers, nausea, appetite changes, melena, hematochezia, or diarrhea. He underwent an upper endoscopy and colonoscopy one year ago revealing one small tubular adenoma. He has no history of abdominal surgeries. Exam revealed non-distended abdomen, normoactive bowel sounds, left lower quadrant tenderness, no guarding or rigidity, and no palpable masses. Lab work up including autoimmune panel and inflammatory markers were negative. CT revealed normal bowel loops and hazy appearance of the mid mesentery seen with sclerosing mesenteritis. Steroids initiated and he underwent an inguinal lymph node biopsy for further evaluation. Pathology revealed atypical lymphoid proliferation with CD10+ lambda restricted B-cell population consistent with follicular lymphoma.
Discussion: Sclerosing mesenteritis is usually discovered incidentally on imaging for evaluation of non-specific abdominal symptoms. 10-15% of patients are asymptomatic or have minimal symptoms. Abdominal pain is the most common symptom and obstruction is a complication. Treatment can relieve symptoms but doesn't improve prognosis or prevent progression. For non-obstructive symptoms, steroids and tamoxifen can be offered. Surgery is limited to patients with obstructive complications. The pathogenesis is unclear however some mechanisms include trauma, abdominal surgery, autoimmune disease, ischemia and malignancy. Underlying malignancy has been reported from 1-75% in patients as a paraneoplastic syndrome. Non-Hodgkin lymphoma is most commonly associated. Our patient didn't have abdominal surgery, trauma, ischemia or immune mediated conditions. An inguinal node biopsy resulted in a diagnosis of follicular lymphoma. A lymph node biopsy should be considered in patients with sclerosing mesenteritis when other etiologies have been ruled out especially in patients with B-symptoms such as ours.
Figure: Normal bowel loops and hazy appearance of the mid mesentery (arrow).
Fathima Suhail indicated no relevant financial relationships.
Abdul Bhutta indicated no relevant financial relationships.
Bishnu Sapkota indicated no relevant financial relationships.
Fathima K. Suhail, MD1, Abdul Bhutta, MD1, Bishnu Sapkota, MD, FACG2. P2003 - Sclerosing Mesenteritis: A Paraneoplastic Phenomenon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.