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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 for mesenteritis should be based on the stage of disease. In most cases, laparotomy with biopsy for diagnosis is sufficient. However, for cases presenting with bowel obstruction, surgery is recommended. As nodular mass can mimic neoplastic lesion clinically and radiologically, knowledge of this condition is important to make a correct diagnosis and prevent any unwarranted aggressive therapy.
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The first half of the twentieth century played a vital role in the state of the present media. The century commenced with the influx of new forms of media as modernization uncontrollably invaded all social forms. The dominant medium of the nineteenth century, the newspaper, sustained its power at the beginning of the century. Moving pictures, or film, was born and started to form its own cult of ...
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Fig. 1. (a) Two nodular masses seen in the mesenteric fat. (b) Cut surface is yellowish brown and firm. Photomicrograph shows fibro-adipose tissue with widespread fat necrosis. (c) Interspersed chronic inflammatory cells consisting predominantly of lymphocytes and few plasma cells. (d) Hematoxylin and eosin stain C ¥ 100; D ¥ 400.
© 2011 The Authors ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons
ANZ J Surg •• (2011) ••–••
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References
1. Durst AL, Freund H, Rosenmann E, Birnbaum D. Mesenteric panniculitis: review of literature and presentation of cases. Surgery 1977; 81: 203–11. 2. Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy; a single entity? Am. J. Surg. Pathol. 1997; 21: 392–8. 3. Weiser J, Salky B, Slepian S, Dileman S. Laparoscopic diagnosis of retractile mesenteritis. Gastrointest. Endosc. 1992; 38: 615–7. 4. Parra-Davila E, Mckenney MG, Sleeman D et al. Mesenteric panniculitis: case report and literature review. Am. Surg. 1998; 64: 768–71.
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Sunila Jain, MD Deepali Jain, MD Prem Chopra, MD Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India doi: 10.1111/j.1445-2197.2011.05714.x
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© 2011 The Authors ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons
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Journal Code: ANS Article No: 5714 Page Extent: 2 Toppan Best-set Premedia Limited Proofreader: Mony Delivery date: 17 March 2011 Copyeditor:
AUTHOR QUERY FORM
Dear Author During the preparation of your manuscript, the questions listed below have arisen. Please answer all the queries (marking any other corrections on the proof enclosed) and return this form with your proofs.
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AUTHOR: ‘surgerical’ has been changed to ‘surgical’. Please confirm if this is correct. AUTHOR: The meaning of the sentence ‘Grossly, two nodular lesions . . .’ is not clear. Please rewrite or confirm that the sentence is correct. AUTHOR: ‘laproscopy’ has been changed to ‘laparoscopy’. Please confirm if this is correct. AUTHOR: Please confirm if the sentence ‘Trauma, drugs, autoimmune disorders . . .’ is correct.