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Sclerosing Mesenteritis

Depiction by Multidetector CT and Three-Dimensional Volume Rendering

Leo P. Lawler1, Denis M. McCarthy2, Elliot K. Fishman1 and Ralph Hruban2

1 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N. Caroline St., Rm. 3254, Baltimore, MD 21287.
2 Department of Pathology, Johns Hopkins Medical Institution, 600 N. Wolfe St., Baltimore, MD 21287.



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  		Fig. 1A. —74-year-old man with weight loss, abdominal pain, and diarrhea. Axial CT scan shows superior mesenteric artery with halo of fat (long thin arrow) coursing through mass (m) of sclerosing mesenteritis. Mass is posterior to junction of head and neck of pancreas (h) and anterior to loop of jejunum (j). Perihepatic varices (short thin arrow), mesenteric stranding, and ascites (open arrows) are noted. Second part of duodenum (thick arrow) is marked as landmark.

 


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  		Fig. 1B. —74-year-old man with weight loss, abdominal pain, and diarrhea. Coronal anterior volume-rendered image shows superior mesenteric artery displaced to left with fatty halo (long black arrow) coursing through superior mesenteric mass (m) that has focus of calcification (c). Superior mesenteric vein is occluded just short of portosplenic confluence (curved arrow). Varices are noted in mesentery (white arrow) and in peritoneum (short black arrows). Entire extent of mass in coronal plane is depicted on this image. p = pancreas tail.

 


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  		Fig. 1C. —74-year-old man with weight loss, abdominal pain, and diarrhea. Sagittal oblique volume-rendered image shows mass (m) encasing irregular superior mesenteric artery (long black arrow) that courses through mass to its most caudad aspect, which has focus of coarse calcification (c). Most cephalad aspect of mass is posteroinferior to splenic vein (long white arrow), pancreas (open arrow), and splenic artery (short white arrow). Mass is adjacent to loop of jejunum (j), but clear plane is seen between them. Note celiac artery (short black arrow). Entire extent of mass in sagittal plane is depicted on this image.

 


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  		Fig. 1D. —74-year-old man with weight loss, abdominal pain, and diarrhea. Coronal posterior volume-rendered perspective shows jejunoileal (small black arrow) and ileocolic (large black arrow) branches of superior mesenteric artery as they course through mass. Relationship to pancreas tail (P) and splenic vein (white arrow) is noted. Spleen (S) and liver (L) are illustrated.

 


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  		Fig. 1E. —74-year-old man with weight loss, abdominal pain, and diarrhea. Photomicrograph of histologic specimen of mesenteric mass at low magnification shows dense fibrous tissue (open arrow) surrounding entrapped adipocytes (solid straight arrow) and collections of dense lymphoplasmacytic infiltrate (curved arrow). Immunohistochemical stains and flow cytometry showed lymphoid population was polyclonal. (H and E, x100)

 


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  		Fig. 1F. —74-year-old man with weight loss, abdominal pain, and diarrhea. Photomicrograph of specimen of mesenteric mass at higher magnification shows dense keloidlike collagen (arrow). This feature is somewhat unusual in sclerosing mesenteritis and suggests chronic inflammatory change. (H and E, x200)

 

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