Mesenteric panniculitis: a paraneoplastic phenomenon?

BACKGROUND: Mesenteric panniculitis is an inflammatory condition of mesenteric adipose tissue with characteristic features on abdominal CT imaging. Although its cause is unknown, it has been associated with malignancy. OBJECTIVE: The aim of this study was to determine the prevalence of malignancy in patients identified as having mesenteric panniculitis on CT imaging and to identify demographic, clinical, and radiological features that may predict an unknown underlying malignancy. DESIGN: This study is a retrospective analysis of medical records and imaging. SETTING: This study was conducted at Christchurch Hospital, Canterbury District Health Board, New Zealand. PATIENTS: Individuals with mesenteric panniculitis on abdominal CT imaging performed between 2003 and 2010 were included. RESULTS: One hundred eighteen (92 male; median age, 61 years; range, 20-88 years) patients were identified with mesenteric panniculitis. Malignancy was identified in 45 patients (38%) (34 male). The most common malignancies were colorectal (14), lymphoma (13), and urogenital tract (7). Malignancies were diagnosed after the detection of mesenteric panniculitis in 13 patients. Univariate analysis of demographic, clinical, and radiological features revealed that lymph node size >12 mm (relative risk 4.5 (CI 1.4-14.6); p = 0.0266) and the absence of the fat ring sign (relative risk 0.6 (0.3-1.1); p = 0.047) were associated with the subsequent diagnosis of malignancy in patients with mesenteric panniculitis. LIMITATIONS: This review was limited by its retrospective nature and the small number of individuals with diagnosis of malignancy after the detection of mesenteric panniculitis. CONCLUSION: Mesenteric panniculitis is often associated with an underlying malignancy. In most cases, malignancy is diagnosed before mesenteric panniculitis. Lymph node size (>12 mm) and the absence of the fat ring sign were identified as predictors of subsequent diagnosis of malignancy in patients with mesenteric panniculitis. Identification of mesenteric panniculitis on imaging should prompt an awareness for possible malignancy in these patients.

CT-diagnosed mesenteric alterations in patients with non-Hodgkin's lymphoma: a population-based study.

BACKGROUND: Mesenteric alterations are associated with non-Hodgkin's lymphoma (NHL), but the frequency and prognostic value of mesenteric alterations are unknown in patients with NHL. PATIENTS AND METHODS: We retrospectively screened 120 patients that were treated for NHL between January 1996 and December 2001 for the presence of mesenteric alterations, defined on computed tomography (CT) scans as nodular or diffuse infiltration of the abdominal mesentery with increased density of mesenteric fat. RESULTS: 21 patients (17.5%) had radiological findings of mesenteric alterations at the time of the initial NHL diagnosis. Mesenteric alterations were significantly associated with mesenteric lymphadenopathy (p = 0.01). In about 50% of the patients, mesenteric alterations could not be explained by direct mesenteric tumour invasion or overt lymphatic obstruction. Patients with initial findings of mesenteric alterations tended to have a better 4-year survival as compared to patients without such findings (79 vs. 43%, p = 0.11). The International Prognostic Index (IPI) score was the only independent predictor of survival in the multivariate analysis. CONCLUSION: This retrospective screening study found a moderate prevalence of mesenteric alterations in patients with various subtypes of NHL. The diagnostic and prognostic value of mesenteric alterations should be further assessed in prospective studies.