Friday, December 21, 2007

Pancreatic More Condition_symptoms



Mesenteric panniculitis was first described by Jura in 1924 as sclerosing mesenteritis. Other terms used to define this process are those of mesenteritis retractable lipogranuloma of mesenteric lipodystrophy mesenteritis isolated or xanthogranulomatous.

disease is more common in males (2-3:1) and a greater prevalence of over 50 years.

Patients with mesenteric panniculitis show variation in clinical presentation from asymptomatic to abdominal pain accompanied by nausea, fever, malaise, weight loss. 50% cases manifests as a poorly defined abdominal mass.

The lesion may progress to a state of fibrosis or self-limiting. The etiology is unclear, trauma, drugs, autoimmune, infection, vascular or previous surgery have been postulated as possible causes.

series from the Mayo Clinic ranks mesenteric panniculitis that affects the mesentery of the small intestine into three types: Type

I. 42%: diffuse thickening of the mesentery from the root to the edges of the small intestine.

Type II. 32%: isolated nodular mass in the mesenteric root.

Type III. 26%: the mesentery contains multiple nodules of variable size.

There is no specific treatment. In most cases diagnostic laparotomy with biopsy is often sufficient, in case of intestinal obstruction, as occurred in our patient may require partial resection. There are reports of response to steroids, antibiotics, RT and cyclophosphamide.

DIFFERENTIAL DIAGNOSIS Diagnosis Differential includes, among others, fibrosis and chronic inflammatory infiltrate due to foreign body (talc), desmoplastic metastatic carcinoma, mesenteric fibromatosis, inflammatory liposarcoma, sclerosing lymphoma, inflammatory pseudotumor, reaction to adjacent cancer or chronic abscess (xanthogranulomatous pyelonephritis, diverticulitis, visceral perforation ) and Whipple's disease ( Table 1).

metastatic carcinoma: some carcinomas can cause mesenteric fibrosis, inflammation and necrosis. The diagnosis can be confirmed by clinical history or history means and immunohistochemistry.

mesenteric fibromatosis: hypocellular collagenous tissue that is not accompanied by inflammatory infiltrates and reaches up to the muscularis propria of the intestinal wall.

inflammatory fibrosarcoma: higher cellularity showing severe nuclear atypia and presence of mitosis.

retroperitoneal fibrosis: can be the same process that affects different regions, although the retroperitoneal fibrosis has been associated with drugs such as methysergide or other processes sclerosis (Riedel's thyroiditis, biliary duct sclerosis ...).

inflammatory pseudotumor, clinically manifested leukocytosis, increased sedimentation rate, anemia. Histologically, abscesses stresses the plasma cell.

Whipple's disease: when the disease affects the mesentery or retroperitoneal lymph lipogranulomatosa shows inflammation associated with large rounded optically empty spaces. The technique of PAS positive in this condition and not in the mesenteric panniculitis.

inflammatory liposarcoma: lymphoplasmacytic aggregates has also, bands of sclerosis, sometimes masking the inflammatory infiltrate atypical adipocytes. Usually light areas of liposarcoma.

sclerosing lymphoma: non-Hodgkin lymphomas affecting the mesentery are accompanied by dense fibrosis. Kipfer In the study, 15% of patients with mesenteric panniculitis developed a malignant lymphoma. Although mesenteric panniculitis can be considered a premalignant condition, their appearance may also be due to a poor sampling in cases of sclerosing lymphoma. Mesenteric lymphomas show areas of follicular or nodular growth in the follicles appear close to each other. In a small outlet fibrosis associated with lymphoma can be confused with mesenteric panniculitis.

Weber-Christian disease, is an inflammatory disorder of fat that occurs in young women, mainly affecting the skin. There are reports of involvement of the mesentery, retroperitoneum, and pericardium.

BIBLIOGRAPHY

Kelly JK, Wei-Sek H. Idiopathic retractile (sclerosing) mesenteritis and Its differential diagnosis. Am J Surg Pathol 1989, 13: 513-521

Emory TS, Moniham JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteritic panniculitis and mesenteric lipodystrophy: a single entity? Am J Surg Pathol 1997, 21: 392-398

Kipfer RE, Moetel CG, Dahlin DC. Mesenteric lipodystrophy. Ann Intern Med 1974; 80: 582-588

Serrano, R. et al. Ruber Clinic. Madrid. Mesenteric panniculitis. 2002
http://www.seap.es/regional/madrid/diciembre01/clruberdg.htm

TABLE 1 . Mesenteric inflammatory lesions: differential diagnosis

mesenteric panniculitis (sclerosing mesenteritis)

Trauma

inflammatory process that affects kidney, appendix, pancreas.

Malakoplakia

Malignant lymphoma with sclerosis

metastatic carcinoma (carcinoma lobular carcinoma of signet ring cells)

mesenteric fibromatosis

Weber-Christian disease

Inflammatory pseudotumor

inflammatory liposarcoma and fibrosarcoma

Whipple disease

2002

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