Sclerosing mesenteritis: A real manifestation or histological mimic of IgG4-related disease?

Pathology International
Mehmet Ozgur AvincsalYoh Zen

Abstract

We present three cases of sclerosing mesenteritis and review the literature to learn whether or not sclerosing mesenteritis is an IgG4-related disease (IgG4-RD). Our patients were all adult males. Their mesenteric masses ranged from 6.5 to 14.5 cm in the greatest diameter. Tissue specimens showed moderate to severe lymphoplasmacytic infiltration with occasional eosinophils against a background of irregular fibrosis. Both obliterative phlebitis and storiform fibrosis were noted in all cases. IgG4+ plasma cells were moderately increased in number (46 to 85 cells/high-power field). However, unlike IgG4-RD, the IgG4+/IgG+ plasma cell ratio was <40% (28% to 35%). Serum IgG4 concentrations were also within the normal range (43.2 to 105 mg/dL; normal range <135 mg/dL). Two biopsy cases showed spontaneous regression on imaging approximately 5 months later. No sclerosing conditions were found in other organs. The literature review identified 11 additional cases of sclerosing mesenteritis with IgG4+ plasma cell infiltration. However, conclusive cases with four characteristic features (high serum IgG4 levels, tissue IgG4 elevation, multi-organ involvement, and effective response to glucocorticoid therapy) have never been reported. In conc...Continue Reading

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Citations

May 22, 2016·Rheumatology International·Juan González-MorenoNorberto Ortego Centeno
Dec 23, 2017·Revista Española De Enfermedades Digestivas : Organo Oficial De La Sociedad Española De Patología Digestiva·María de Los Ángeles Mejías ManzanoEduardo Leo Carnerero
Mar 5, 2019·The American Journal of Gastroenterology·Christopher J DanfordJacqueline L Wolf
Aug 3, 2017·BMC Pediatrics·Cui-Ping LiangSi-Tang Gong
Dec 10, 2017·Der Radiologe·L P Beyer, A Schreyer
Jul 12, 2019·Pathology International·Masashi MiyaokaNaoya Nakamura
Jan 29, 2019·The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi·Tae Hyung KwonYoon Suk Lee
Nov 12, 2019·Internal Medicine·Masahide FukudaRyoji Kushima

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