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.