Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10601-10608
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10601
Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms
Eli D Ehrenpreis, Grigory Roginsky, Richard M Gore
Eli D Ehrenpreis, Grigory Roginsky, University of Chicago, Center for the Study of Complex Diseases, Gastroenterology, NorthShore University HealthSystem, Highland Park Hospital, Highland Park, IL 60035, United States
Richard M Gore, Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, United States
Author contributions: Ehrenpreis ED contributed to conception and design of the study, data acquisition, analysis and interpretation of data, drafting the article, making critical revisions related to important intellectual content of the manuscript and final approval of the version of the article to be published; Roginsky G contributed to data acquisition, analysis and interpretation of data, drafting the article, making critical revisions and final approval of the version of the article to be published; Gore RM contributed to data acquisition, analysis and interpretation of data, drafting the article and final approval of the version of the article to be published.
Supported by An unrestricted grant from the Keyser Family Fund (partly).
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Institutional review board statement: This study was approved by the Institutional Review Board of NorthShore University HealthSystem.
Informed consent statement: Informed consent for this retrospective study was waived by the Institutional Review Board.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eli D Ehrenpreis, MD, Associate Professor of Clinical Medicine, Director, Staff Physician, University of Chicago, Center for the Study of Complex Diseases, Gastroenterology, NorthShore University HealthSystem, Highland Park Hospital, 777 Park Avenue West, Highland Park, IL 60035, United States. ehrenpreis@gipharm.net
Telephone: +1-11-8476571900
Received: October 14, 2016
Peer-review started: October 16, 2016
First decision: October 28, 2016
Revised: November 14, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 28, 2016
Abstract
AIM

To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography (CT).

METHODS

All abdominal CT scans performed at NorthShore University HealthSystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet (RadNet Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.

RESULTS

In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fifty-nine patients had mesenteric panniculitis (MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients (22.6%) had a known history of cancer at the time of their CT scan. Nineteen (5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these (14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MP-like findings on CT (36 cases, 36%), with follicular lymphoma being the most frequent subtype (17/36). A variety of solid tumors, most commonly prostate (7) and renal cell cancers (6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45 (80%), worsened in 6 (11%), and improved in 5 patients (9%). Positron emission tomography (PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients (5%).

CONCLUSION

A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.

Keywords: Panniculitis, Peritoneal, X ray, Neoplasms, Computed tomography, Small intestine, Misty mesentery, Lymphoma, Tomography, Positron emission tomography

Core tip: The most important question when a patient has new mesenteric panniculitis - like findings on abdominal computed tomography (CT) scan is the likelihood that a malignancy is present. Based on our study, a first diagnosis of cancer occurs in approximately 5% and is unexpected diagnosis in 1.4% of these patients. Lymphomas are the most likely malignancies. A careful clinical evaluation for lymphoma as well as solid tumors is advised. Follow up is also important, as an additional 5% of patients will eventually be diagnosed with a malignancy. In patients with a malignancy, CT findings are likely to remain stable, and positron emission tomography scanning is not advised.