Sclerosing Mesenteritis Involving the Pancreas: A Mimicker of Pancreatic Cancer
JR Scudiere, K Horton, J Herman, E Fishman, R Schulick, C Wolfgang, E Montgomery, R Hruban. The Johns Hopkins Medical Institutions, Baltimore, MD
Background: Sclerosing mesenteritis, also known as mesenteric lipodystrophy, rarely involves the pancreatic parenchyma. When it does involve the pancreas, sclerosing mesenteritis can mimic pancreatic carcinoma both clinically and radiographically, creating substantial diagnostic and treatment challenges.
Design: We report 12 cases of sclerosing mesenteritis involving the pancreatic parenchyma, and review their clinical presentation, radiographic findings, pathology, and outcome.
Results: The clinical and radiologic impression for 7 of these 12 patients was a primary pancreatic neoplasm. The mean age at presentation was 56.7 years (range 16-78 years). Five patients were men and 7 were women. Of the 11 patients with recorded clinical presentation information available, 9 reported abdominal or epigastric pain, 5 reported weight loss, and 2 reported one or more of the following: back pain/pain radiating to the back, fever, abdominal bloating or distention, nausea with or without vomiting, and anorexia. In each case, the lesion formed a tumefactive mass with an infiltrative pattern that involved the pancreas. All cases had the 3 key histologic features of sclerosing mesenteritis- fibrosis, chronic inflammation, and fat necrosis- in the absence of known etiology. As in other locations, the cases of sclerosing mesenteritis involving the pancreas contained a mixture of lymphocytes, plasma cells, and scattered eosinophils. Of the 10 patients with treatment and follow-up information available, 5 responded to treatment (either resection, steroids, tamoxifen, azathioprine, or a combination) and 5 showed no response in follow-up ranging from several days to ten years after diagnosis. A dramatic response to immunosuppressive therapy is illustrated by the case of a 46-year-old woman who presented for treatment evaluation following the presumptive diagnosis of an inoperable pancreatic cancer.
Conclusions: Distinguishing patients with sclerosing mesenteritis involving the pancreas from those who have pancreatic cancer is crucial to appropriate management, as patients with sclerosing mesenteritis may benefit greatly from immunosuppression.
Category: Liver & Pancreas
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 224, Wednesday Morning