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AFIP Archives - From the Archives of the AFIP

Benign Fibrous Tumors and Tumorlike Lesions of the Mesentery: Radiologic-Pathologic Correlation

Published Online:Jan 1 2006https://doi.org/10.1148/rg.261055151

Abstract

Mesenteric fibromatosis, sclerosing mesenteritis, inflammatory pseudotumor, and extrapleural solitary fibrous tumor constitute a loosely associated group of benign fibrous tumors and tumorlike lesions of the mesentery. These lesions are linked histologically by the presence of fibroblasts or fibrosis and anatomically by their location within the mesentery. Although rare, and distinctly different in pathogenesis and biologic behavior, these fibrous lesions have pathologic and radiologic features that overlap with one another and with more common neoplastic and nonneoplastic lesions of the mesentery. Mesenteric fibromatosis is a locally aggressive, benign proliferative process that may occur sporadically or in association with familial adenomatous polyposis. It most frequently manifests as a focal mesenteric mass and may simulate lymphoma, metastatic disease, or a soft-tissue sarcoma. Sclerosing mesenteritis is a rare idiopathic disorder that most commonly produces a stellate mass within the mesentery and should be differentiated from metastatic disease, specifically metastatic carcinoid, because it frequently responds to conservative or medical management. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) is a benign, chronic inflammatory disorder of unknown cause that manifests as a solid mesenteric mass, indistinguishable from malignancy. Extrapleural solitary fibrous tumor is a tumor of submesothelial origin that is identical to the solitary fibrous tumor of the pleura. When located in the mesentery or peritoneal cavity, extrapleural solitary fibrous tumor has an imaging pattern that must be differentiated from metastatic disease, soft-tissue sarcomas, and other benign and malignant neoplasms of the mesentery and peritoneum. Knowledge of this group of benign fibrous tumors and tumorlike lesions of the mesentery is important in the preoperative evaluation of a mesenteric mass.

References

  • 1 KempsonRL, Fletcher CD, Evans HL, Hendrickson MR, Sibley RK. Tumors of the soft tissues. Washington, DC: Armed Forces Institute of Pathology, 1998.
    Google Scholar
  • 2 BurkeAP, Sobin LH, Shekitka KM, Federspiel BH, Helwig EB. Intra-abdominal fibromatosis: a pathologic analysis of 130 tumors with comparison of clinical subgroups. Am J Surg Pathol1990; 14(4): 335–341.
    MedlineGoogle Scholar
  • 3 ReitamoJJ, Hayry P, Nykyri E, Saxen E. The desmoid tumor. I. Incidence, sex-, age- and anatomical distribution in the Finnish population. Am J Clin Pathol1982; 77(6): 665–673.
    MedlineGoogle Scholar
  • 4 LotfiAM, Dozois RR, Gordon H, et al. Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment. Int J Colorectal Dis1989; 4(1): 30–36.
    MedlineGoogle Scholar
  • 5 RiddelRH, Petras RE, Williams GT, Sobin LH. Tumors of the intestines. Washington, DC: Armed Forces Institute of Pathology, 2002.
    Google Scholar
  • 6 ScottRJ, Froggatt NJ, Trembath RC, Evans DG, Hodgson SV, Maher ER. Familial infiltrative fibromatosis (desmoid tumours) (MIM135290) caused by a recurrent 3′ APC gene mutation. Hum Mol Genet1996; 5(12): 1921–1924.
    MedlineGoogle Scholar
  • 7 EcclesDM, van der Luijt R, Breukel C, et al. Hereditary desmoid disease due to a frameshift mutation at codon 1924 of the APC gene. Am J Hum Genet1996; 59(6): 1193–1201.
    MedlineGoogle Scholar
  • 8 SmithAJ, Lewis JJ, Merchant NB, Leung DH, Woodruff JM, Brennan MF. Surgical management of intra-abdominal desmoid tumours. Br J Surg2000; 87(5): 608–613.
    MedlineGoogle Scholar
  • 9 MiettinenM, Monihan JM, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol1999; 23(9): 1109–1118.
    MedlineGoogle Scholar
  • 10 BaronRL, Lee JK. Mesenteric desmoid tumors: sonographic and computed tomographic appearance. Radiology1981; 140(3): 777–779.
    Google Scholar
  • 11 ChurchJM. Mucosal ischemia caused by desmoid tumors in patients with familial adenomatous polyposis: report of four cases. Dis Colon Rectum1998; 41(5): 661–663.
    MedlineGoogle Scholar
  • 12 MaconiG, Cristaldi M, Vago L, et al. Clinical, ultrasonographic and tomographic features on the natural evolution of primary mesenteric fibromatosis: a case report. Hepatogastroenterology1998; 45(23): 1663–1666.
    MedlineGoogle Scholar
  • 13 CasillasJ, Sais GJ, Greve JL, Iparraguirre MC, Morillo G. Imaging of intra- and extraabdominal desmoid tumors. RadioGraphics1991; 11(6): 959–968.
    Google Scholar
  • 14 EinsteinDM, Tagliabue JR, Desai RK. Abdominal desmoids: CT findings in 25 patients. AJR Am J Roentgenol1991; 157(2): 275–279.
    MedlineGoogle Scholar
  • 15 FariaSC, Iyer RB, Rashid A, Ellis L, Whitman GJ. Desmoid tumor of the small bowel and the mesentery. AJR Am J Roentgenol2004; 183(1): 118.
    MedlineGoogle Scholar
  • 16 MagidD, Fishman EK, Jones B, Hoover HC, Feinstein R, Siegelman SS. Desmoid tumors in Gardner syndrome: use of computed tomography. AJR Am J Roentgenol1984; 142(6): 1141–1145.
    MedlineGoogle Scholar
  • 17 KawashimaA, Goldman SM, Fishman EK, et al. CT of intraabdominal desmoid tumors: is the tumor different in patients with Gardner’s disease? AJR Am J Roentgenol1994; 162(2): 339–342.
    MedlineGoogle Scholar
  • 18 AziziL, Balu M, Belkacem A, Lewin M, Tubiana JM, Arrive L. MRI features of mesenteric desmoid tumors in familial adenomatous polyposis. AJR Am J Roentgenol2005; 184(4): 1128–1135.
    MedlineGoogle Scholar
  • 19 HealyJC, Reznek RH, Clark SK, Phillips RK, Armstrong P. MR appearances of desmoid tumors in familial adenomatous polyposis. AJR Am J Roentgenol1997; 169(2): 465–472.
    MedlineGoogle Scholar
  • 20 LevyAD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. RadioGraphics2003; 23(2): 283–304.
    Google Scholar
  • 21 BruceJM, Bradley EL 3rd, Satchidanand SK. A desmoid tumor of the pancreas: sporadic intra-abdominal desmoids revisited. Int J Pancreatol1996; 19(3): 197–203.
    MedlineGoogle Scholar
  • 22 KonoT, Tomita I, Chisato N, Matsuda M, Kakisaka A, Kasai S. Successful low-dose chemotherapy using vinblastine and methotrexate for the treatment of an ileoanal pouch mesenteric desmoid tumor: report of a case. Dis Colon Rectum2004; 47(2): 246–249.
    MedlineGoogle Scholar
  • 23 PosnerMC, Shiu MH, Newsome JL, Hajdu SI, Gaynor JJ, Brennan MF. The desmoid tumor: not a benign disease. Arch Surg1989; 124(2): 191–196.
    MedlineGoogle Scholar
  • 24 TonelliF, Ficari F, Valanzano R, Brandi ML. Treatment of desmoids and mesenteric fibromatosis in familial adenomatous polyposis with raloxifene. Tumori2003; 89(4): 391–396.
    MedlineGoogle Scholar
  • 25 WilckenN, Tattersall MH. Endocrine therapy for desmoid tumors. Cancer1991; 68(6): 1384–1388.
    MedlineGoogle Scholar
  • 26 SagarPM, Moslein G, Dozois RR. Management of desmoid tumors in patients after ileal pouchanal anastomosis for familial adenomatous polyposis. Dis Colon Rectum1998; 41(11): 1350–1355; discussion 1355–1356.
    MedlineGoogle Scholar
  • 27 NgSH, Wong HF, Ko SF, Tsai CC. Retractile mesenteritis with colon and retroperitoneum involvement: CT findings. Gastrointest Radiol1992; 17(4): 333–335.
    MedlineGoogle Scholar
  • 28 HanSY, Koehler RE, Keller FS, Ho KJ, Zornes SL. Retractile mesenteritis involving the colon: pathologic and radiologic correlation (case report). AJR Am J Roentgenol1986; 147(2): 268–270.
    MedlineGoogle Scholar
  • 29 EmoryTS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity? Am J Surg Pathol1997; 21(4): 392–398.
    MedlineGoogle Scholar
  • 30 SabateJM, Torrubia S, Maideu J, Franquet T, Monill JM, Perez C. Sclerosing mesenteritis: imaging findings in 17 patients. AJR Am J Roentgenol1999; 172(3): 625–629.
    MedlineGoogle Scholar
  • 31 DehnerLP, Coffin CM. Idiopathic fibrosclerotic disorders and other inflammatory pseudotumors. Semin Diagn Pathol1998; 15(2): 161–173.
    MedlineGoogle Scholar
  • 32 KellyJK, Hwang WS. Idiopathic retractile (sclerosing) mesenteritis and its differential diagnosis. Am J Surg Pathol1989; 13(6): 513–521.
    MedlineGoogle Scholar
  • 33 FujiyoshiF, Ichinari N, Kajiya Y, et al. Retractile mesenteritis: small-bowel radiography, CT, and MR imaging. AJR Am J Roentgenol1997; 169(3): 791–793.
    MedlineGoogle Scholar
  • 34 MataJM, Inaraja L, Martin J, Olazabal A, Castilla MT. CT features of mesenteric panniculitis. J Comput Assist Tomogr1987; 11(6): 1021–1023.
    MedlineGoogle Scholar
  • 35 VallsC. Fatring sign in sclerosing mesenteritis. AJR Am J Roentgenol2000; 174(1): 259–260.
    MedlineGoogle Scholar
  • 36 JohnsonLA, Longacre TA, Wharton KA Jr, Jeffrey RB. Multiple mesenteric lymphatic cysts: an unusual feature of mesenteric panniculitis (sclerosing mesenteritis). J Comput Assist Tomogr1997; 21(1): 103–105.
    MedlineGoogle Scholar
  • 37 KawashimaA, Fishman EK, Hruban RH, Kuhlman JE, Lee RP. Mesenteric panniculitis presenting as a multilocular cystic mesenteric mass: CT and MR evaluation. Clin Imaging1993; 17(2): 112–116.
    MedlineGoogle Scholar
  • 38 Badiola-VarelaCM, Sussman SK, Glickstein MF. Mesenteric panniculitis: findings on CT, MRI, and angiography— case report. Clin Imaging1991; 15(4): 265–267.
    MedlineGoogle Scholar
  • 39 KronthalAJ, Kang YS, Fishman EK, Jones B, Kuhlman JE, Tempany CM. MR imaging in sclerosing mesenteritis. AJR Am J Roentgenol1991; 156(3): 517–519.
    MedlineGoogle Scholar
  • 40 KakitsubataY, Umemura Y, Kakitsubata S, et al. CT and MRI manifestations of intraabdominal panniculitis. Clin Imaging1993; 17(3): 186–188.
    MedlineGoogle Scholar
  • 41 KobayashiS, Takeda K, Tanaka N, Hirano T, Nakagawa T, Matsumoto K. Mesenteric panniculitis: MR findings. J Comput Assist Tomogr1993; 17(3): 500–502.
    MedlineGoogle Scholar
  • 42 JamarF, Fiasse R, Leners N, Pauwels S. Somatostatin receptor imaging with indium-111-pentetreotide in gastroenteropancreatic neuroendocrine tumors: safety, efficacy and impact on patient management. J Nucl Med1995; 36(4): 542–549.
    MedlineGoogle Scholar
  • 43 ScherublH, Bader M, Fett U, et al. Somatostatin-receptor imaging of neuroendocrine gastroenteropancreatic tumors. Gastroenterology1993; 105(6): 1705–1709.
    MedlineGoogle Scholar
  • 44 PanushRS, Yonker RA, Dlesk A, Longley S, Caldwell JR. Weber-Christian disease: analysis of 15 cases and review of the literature. Medicine (Baltimore)1985; 64(3): 181–191.
    MedlineGoogle Scholar
  • 45 DurstAL, Freund H, Rosenmann E, Birnbaum D. Mesenteric panniculitis: review of the literature and presentation of cases. Surgery1977; 81(2): 203–211.
    MedlineGoogle Scholar
  • 46 KoornstraJJ, van Olffen GH, van Noort G. Retractile mesenteritis: to treat or not to treat. Hepatogastroenterology1997; 44(14): 408–410.
    MedlineGoogle Scholar
  • 47 BalaA, Coderre SP, Johnson DR, Nayak V. Treatment of sclerosing mesenteritis with corticosteroids and azathioprine. Can J Gastroenterol2001; 15(8): 533–535.
    MedlineGoogle Scholar
  • 48 TytgatGN, Roozendaal K, Winter W, Esseveld MR. Successful treatment of a patient with retractile mesenteritis with prednisone and azathioprine. Gastroenterology1980; 79(2): 352–356.
    MedlineGoogle Scholar
  • 49 DayDL, Sane S, Dehner LP. Inflammatory pseudotumor of the mesentery and small intestine. Pediatr Radiol1986; 16(3): 210–215.
    MedlineGoogle Scholar
  • 50 MiettinenM. Diagnostic soft tissue pathology. Philadelphia, Pa: Churchill Livingstone, 2003.
    Google Scholar
  • 51 UysalS, Tuncbilek I, Unlubay D, Tiras U, Bilaloglu P, Kosar U. Inflammatory pseudotumor of the sigmoid colon mesentery: US and CT findings. Eur Radiol2005; 15(3): 633–635.
    MedlineGoogle Scholar
  • 52 NarlaLD, Newman B, Spottswood SS, Narla S, Kolli R. Inflammatory pseudotumor. RadioGraphics2003; 23(3): 719–729.
    Google Scholar
  • 53 SlavotinekJP, Bourne AJ, Sage MR, Freeman JK. Inflammatory pseudotumour of the pancreas in a child. Pediatr Radiol2000; 30(11): 801–803.
    MedlineGoogle Scholar
  • 54 GoodladJR, Fletcher CD. Solitary fibrous tumour arising at unusual sites: analysis of a series. Histopathology1991; 19(6): 515–522.
    MedlineGoogle Scholar
  • 55 YoungRH, Clement PB, McCaughey WT. Solitary fibrous tumors (‘fibrous mesotheliomas’) of the peritoneum: a report of three cases and a review of the literature. Arch Pathol Lab Med1990; 114(5): 493–495.
    MedlineGoogle Scholar
  • 56 AdachiT, Sugiyama Y, Saji S. Solitary fibrous benign mesothelioma of the peritoneum: report of a case. Surg Today1999; 29(9): 915–918.
    MedlineGoogle Scholar
  • 57 KubotaY, Kawai N, Tozawa K, Hayashi Y, Sasaki S, Kohri K. Solitary fibrous tumor of the peritoneum found in the prevesical space. Urol Int2000; 65(1): 53–56.
    MedlineGoogle Scholar

Article History

Published in print: Jan 2006