Skip to main content

Advertisement

SpringerLink
Log in

More than just metastases: a practical approach to solid mesenteric masses

  • Pictorial Essay
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

The abdominal mesenteries are important peritoneal structures that give rise to a wide spectrum of abnormalities, including solid mesenteric masses. Despite similarities in appearance, solid masses in the mesentery may have diverse etiologies, ranging from benign to highly malignant. While metastases are the most common cause of solid masses in the mesentery, other less common conditions are also important diagnostic considerations. This article reviews four pathologic entities (sclerosing mesenteritis, carcinoid tumors, desmoids tumors, and gastrointestinal stromal tumors) that may be manifested on abdominal imaging examinations by one or more mesenteric masses. These four pathologic entities are used to present a systematic approach to the radiographic characterization of solid mesenteric masses based on the morphology of the lesions, locoregional effects, and distant findings on various abdominal imaging examinations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Bannister LH (1995) Alimentary system. In: Williams PL (ed) Gray’s anatomy, 38th edn. New York: Churchill Livingstone, pp 1683–1812

    Google Scholar 

  2. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy: a prospective study of prognostic factors. Cancer 63:364–367

    Article  CAS  PubMed  Google Scholar 

  3. Sadeghi B, Arvieux C, Glehen O, et al. (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  CAS  PubMed  Google Scholar 

  4. Akram S, Pardi DS, Schaffner JA, Smyrk TC (2007) Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol 5(5):589–596

    Article  PubMed  Google Scholar 

  5. Kipfer RE, Moertel CG, Dahlin DC (1974) Mesenteric lipodystrophy. Ann Intern Med 80:582–588

    Article  CAS  PubMed  Google Scholar 

  6. Daskalogiannaki ME, Voloudaki A, Prassopoulos P, et al. (2000) CT evaluation of mesenteric panniculitis. AJR Am J Roentgenol 174:427–431

    Article  CAS  PubMed  Google Scholar 

  7. Emory TS, Monihan JM, Carr NJ, Sobin LH (1997) Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity? Am J Surg Pathol 21:392–398

    Article  CAS  PubMed  Google Scholar 

  8. McLaughlin PD, Filippone A, Maher MM (2013) The “Misty Mesentery”: mesenteric panniculitis and its mimics. AJR Am J Roentgenol 200:W116–W123

    Article  PubMed  Google Scholar 

  9. Medina-Franco H, Listinsky C, Mel Wilcox C, et al. (2001) Concomitant sclerosing mesenteritis and bile duct fibrosis simulating Klatskin’s tumor. J Gastrointest Surg 5:658–660

    Article  CAS  PubMed  Google Scholar 

  10. Sabate JM, Torrubia S, Maideu J, et al. (1999) Sclerosing mesenteritis: imaging findings in 17 patients. AJR Am J Roentgenol 172:625–629

    Article  CAS  PubMed  Google Scholar 

  11. Burke AP, Sobin LH, Shekitka KM, Federspiel BH, Helwig EB (1990) Intra-abdominal fibromatosis: a pathologic analysis of 130 tumors with comparison of clinical subgroups. Am J Surg Pathol 14(4):335–341

    Article  CAS  PubMed  Google Scholar 

  12. Fujiyoshi F, Ichinari N, Kajiya Y, et al. (1997) Retractile mesenteritis: small bowel radiography, CT, and MR imaging. AJR Am J Roentgenol 1600(3):791–793

    Article  Google Scholar 

  13. Kobayashi S, Takeda K, Tanaka N, et al. (1993) Mesenteric panniculitis: MR findings. J Comput Assist Tomogr 17:500–502

    Article  CAS  PubMed  Google Scholar 

  14. Kronthal AJ, Kang YS, Fishman EK, et al. (1991) MR imaging in sclerosing mesenteritis. AJR Am J Roentgenol 156:517–519

    Article  CAS  PubMed  Google Scholar 

  15. Zissin R, Metser U, Hain D, Even-Sapir E (2006) Mesenteric panniculitis in oncologic patients: PET-CT findings. Br J Radiol 79:37–43

    Article  CAS  PubMed  Google Scholar 

  16. Koornstra JJ, van Olffen GH, van Noort G (1997) Retractile mesenteritis: to treat or not to treat. Hepatogastroenterology 44:408–410

    CAS  PubMed  Google Scholar 

  17. Bala A, Codere SP, Johnson DR, Nayak V (2001) Treatment of sclerosing mesenteritis with corticosteroids and azathioprine. Can J Gastrenterol 15(8):533–535

    CAS  Google Scholar 

  18. Mazure R, Fernandez MP, Niveloni S, et al. (1998) Successful treatment of retractile mesenteritis with oral progesterone. Gastroenterology 114(6):1313–1317

    Article  CAS  PubMed  Google Scholar 

  19. Ginsburg PM, Ehrenpreis ED (2002) A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis. Aliment Pharmacol Ther 16(12):2115–2122

    Article  CAS  PubMed  Google Scholar 

  20. Rockall A, Reznek R (2007) Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab 21(1):43–68

    Article  CAS  PubMed  Google Scholar 

  21. Tamm E, Kim E, Ng C (2007) Best practice & research clinical endocrinology & metabolism. Hematol Oncol Clin N Am 21:409–432

    Article  Google Scholar 

  22. Bader T, Semelka R, Chiu V, Armao D, Woosley J (2001) MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 14(3):261–269

    Article  CAS  PubMed  Google Scholar 

  23. Strosberg J (2012) Neuroendocrine tumours of the small intestine. Best Pract Res Clin Gastroenterol 26:755–773

    Article  CAS  PubMed  Google Scholar 

  24. Elsayes K, Menias C, Bowerson M, et al. (2011) Imaging of carcinoid tumors: spectrum of findings with pathologic and clinical correlation. J Comput Assist Tomogr 35:72–80

    Article  PubMed  Google Scholar 

  25. Hauso O, Gustafsson BI, et al. (2008) Neuroendocrine tumor epidemiology contrasting Norway and North America. Cancer 113(10):2655–2664

    Article  PubMed  Google Scholar 

  26. Yao JC, et al. (2008) One hundred years after, “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072

    Article  PubMed  Google Scholar 

  27. Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97(4):934–959

    Article  PubMed  Google Scholar 

  28. Caplin ME, Buscombe JR, Hilson AJ, et al. (1998) Carcinoid tumor. Lancet 9130:799–805

    Article  Google Scholar 

  29. Woodard PK, Feldman JM, Paine SS, Baker ME (1995) Midgut carcinoid tumors: CT findings and biochemical profiles. J Comput Assist Tomogr 19:400–405

    Article  CAS  PubMed  Google Scholar 

  30. Burke A, Thomas R, Elsayed A, Sobin L (1997) Carcinoids of the jejunum and ileum: an immunohistochemical and clinic opathologic study of 167 cases. Cancer 79:1086–1093

    Article  CAS  PubMed  Google Scholar 

  31. Pantongrag-Brown L, Buetow P, Carr N, Lichtenstein J, Buck J (1995) Calcification and fibrosis in mesenteric carcinoid tumor: CT findings and pathologic correlation. AJR Am J Roentgenol 164:387–391

    Article  CAS  PubMed  Google Scholar 

  32. Karahan O, Kahriman G, Yikilmaz A, Ozkan M, Bayram F (2006) Gastrointestinal carcinoid tumors in rare locations: imaging findings. Clin Imaging 4:278–282

    Article  Google Scholar 

  33. Sheth S, Horton K, Garland M, Fishman E (2003) Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 23:457–473

    Article  PubMed  Google Scholar 

  34. Gould M, Johnson R (1986) Computed tomography of abdominal carcinoid tumour. Br J Radiol 59(705):881–885

    Article  CAS  PubMed  Google Scholar 

  35. Hall J, Wallace S, Carrasco C, et al. (1989) Gastrointestinal and pancreatic endocrine tumours. Baillière’s Clin Endocrinol Metab 3(1):121–152

    Article  CAS  Google Scholar 

  36. Buck JL, Sobin LH (1990) Carcinoids of the gastrointestinal tract. Radiographics 10:1081–1095

    Article  CAS  PubMed  Google Scholar 

  37. Kaltsas G, Rockall A, Papadogias D, Reznek R, Grossman A (2004) Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol 151(1):15–27

    Article  CAS  PubMed  Google Scholar 

  38. Rufini V, Calcagni ML, Baum RP (2006) Imaging of neuroendocrine tumors. Semin Nucl Med 36:228–247

    Article  PubMed  Google Scholar 

  39. Berge T, Linell F (1976) Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand 84:322–330

    CAS  Google Scholar 

  40. Oberg K (2012) The management of neuroendocrine tumours: current and future medical therapy options. Clin Oncol 24:282–293

    Article  CAS  Google Scholar 

  41. Rinke A, Müller H, Schade-Brittinger C, et al. (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in thecontrol of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from thePROMID study group. J Clin Oncol 27(28):4656–4663

    Article  CAS  PubMed  Google Scholar 

  42. Rubin J, Ajani J, Schirmer W, et al. (1999) Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. J Clin Oncol 17(2):600–606

    CAS  PubMed  Google Scholar 

  43. Casillas J, Sais G, Greve J, Iparraguirre M, Morillo G (1991) Imaging of intra- and extraabdominal desmoid tumors. Radiographics 11(6):959–968

    Article  CAS  PubMed  Google Scholar 

  44. Lee J, Thomas J, Phillips S, Fisher C, Moskovic E (2006) Aggressive fibromatosis: MRI features with pathologic correlation. AJR Am J Roentgenol 186(247):254

    Google Scholar 

  45. Weiss S, Goldblum J, Enzinger F (2008) Fibromatoses. In: Weiss SW, Goldblum JR (eds) Enzinger and Weiss’ soft tissue tumors. Philadelphia: Mosby Elsevier, pp 227–228

    Google Scholar 

  46. Shinagare AB, Ramaiya NH, Jagannathan JP, et al. (2011) A to Z of desmoid tumors. AJR Am J Roentgenol 197(6):1008–1014

    Article  Google Scholar 

  47. Einstein DM, Tagliabue JR, Desai RK (1991) Abdominal desmoids: CT findings in 25 patients. AJR Am J Roentgenol 157:275–279

    Article  CAS  PubMed  Google Scholar 

  48. Escobar C, Munker R, Thomas JO, Li BD, Burton GV (2012) Update on desmoid tumors. Ann Oncol 23(3):562–569

    Article  CAS  PubMed  Google Scholar 

  49. Walker E, Petscavage J, Brian P, et al. (2012) Imaging features of superficial and deep fibromatoses in the adult population. Sarcoma 2012:215810

    Article  PubMed Central  PubMed  Google Scholar 

  50. Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD (2007) Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics 27(1):173–187

    Article  PubMed  Google Scholar 

  51. Kawashima A, Goldman S, Fishman E, et al. (1994) CT of intraabdominal desmoid tumors: is the tumor different in patients with gardner’s disease? AJR Am J Roentgenol 162(2):339–342

    Article  CAS  PubMed  Google Scholar 

  52. Jones I, Jagelman D, Fazio V, et al. (1986) Desmoid tumors in familial polyposis coli. Ann Surg 204:94–97

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Brooks AP, Reznek RH, Nugent K, et al. (1994) CT appearances of desmoid tumors in FAP: further observations. Clin Radiol 49(9):601–607

    Article  CAS  PubMed  Google Scholar 

  54. Levy A, Rimola J, Mehrotra A, Sobin L (2006) From the archives of the AFIP: benign fibrous tumors and tumor like lesions of the mesentery: radiologic pathologic correlation. Radiographics 26:245–264

    Article  PubMed  Google Scholar 

  55. Shields CJ, Winter DC, Kirwan WO, Redmon HP (2001) Desmoid tumors. Eur J Surg Oncol 27(8):701–706

    Article  CAS  PubMed  Google Scholar 

  56. Faria S, Iyer R, Rashid A, Ellis L, Whitman G (2004) Desmoid tumor of the small bowel and the mesentery. AJR Am J Roentgenol 183(1):118

    Article  PubMed  Google Scholar 

  57. McCarville MB, Hoffer FA, Adelman CS, et al. (2007) MRI and biologic behavior of desmoid tumors in children. AJR Am J Roentgenol 189(3):633–640

    Article  PubMed  Google Scholar 

  58. Magid D, Fishman E, Jones B, et al. (1984) Desmoid tumors in gardner syndrome: use of computed tomography. AJR Am J Roentgenol 142(6):1141–1145

    Article  CAS  PubMed  Google Scholar 

  59. Healy JC, Reznek RH, Clark SK, et al. (1997) MR appearances of desmoid tumors in familial adenomatous polyposis. AJR Am J Roentgenol 169:465–472

    Article  CAS  PubMed  Google Scholar 

  60. Grounder MM, Lefkowitz RA, Keohan ML, et al. (2011) Activity of sorafenib against desmoid tumor/deep fibromatosis. Clin Cancer Res 17(12):4082–4090

    Article  Google Scholar 

  61. Mullen J, DeLaney T, Kobayashi W, et al. (2012) Desmoid tumor: analysis of prognostic factors and outcomes in a surgical series. Ann Surg Oncol 19:4028–4035

    Article  PubMed  Google Scholar 

  62. Ballo MT, Zagars GK, Pollack A, et al. (1999) Desmoid tumor: prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol 17:158–167

    CAS  PubMed  Google Scholar 

  63. Lev D, Kotilingam D, Wei C, et al. (2007) Optimizing treatment of desmoid tumors. J Clin Oncol 25(13):1785–1791

    Article  PubMed  Google Scholar 

  64. Burkill GJ, Badran M, Al-Muderis O, et al. (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226(2):527–532

    Article  PubMed  Google Scholar 

  65. Miettenin M, Lasota J (2001) Gastrointestinal stromal tumors-definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchow Arch 438:1–12

    Article  Google Scholar 

  66. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23(2):283–304

    Article  PubMed  Google Scholar 

  67. Tran T, Davila JA, El-Serag HB (2005) The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 100(1):162–168

    Article  PubMed  Google Scholar 

  68. Fuller CE, Williams GT (1991) Gastrointestinal manifestations of type 1 neurofibromatosis (von Recklinghausen’s disease). Histopathology 19:1–11

    Article  CAS  PubMed  Google Scholar 

  69. Boldorini R, Tosoni A, Leutner M, et al. (2001) Multiple small intestinal stromal tumours in a patient with previously unrecognised neurofibromatosis type 1: immunohistochemical and ultrastructural evaluation. Pathology 33:390–395

    CAS  PubMed  Google Scholar 

  70. Sandrasegaran K, Rajesh A, Rushing D, et al. (2005) Gastrointestinal stromal tumors: CT and MRI findings. Eur Radiol 15:1407–1414

    Article  PubMed  Google Scholar 

  71. Nishida T, Kumano S, Sugiura T, et al. (2003) Multidetector CT of high-risk patients with occult gastrointestinal stromal tumors. AJR Am J Roentgenol 180(1):185–189

    Article  PubMed  Google Scholar 

  72. Pidhorecky I, Cheney RT, et al. (2000) Gastrointestinal stromal tumors: current diagnosis, biological behavior, and management. Ann Surg Oncol 7:705–712

    Article  CAS  PubMed  Google Scholar 

  73. Sharp RM, Ansel HJ, Keel SB (2001) Best cases from the AFIP: gastrointestinal stromal tumor. RadioGraphics 21:1557–1560

    Article  CAS  PubMed  Google Scholar 

  74. Kim HC, Lee JM, Son KR, et al. (2004) Gastrointestinal stromal tumors of the duodenum: CT and barium study findings. AJR Am J Roentgenol 183(2):415–419

    Article  PubMed  Google Scholar 

  75. Choi H, Charnsangavej C, Faria SC, et al. (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759

    Article  PubMed  Google Scholar 

  76. Van Den Abbeele AD (2008) The lessons of GIST: a new paradigm for imaging. Oncologist 13(supp2):8–13

    Article  PubMed  Google Scholar 

  77. Chen MY, Bechtold RE, Savage PE (2002) Cystic changes in hetapic metastases from gastrointestinal stromal tumors treated with Gleevec. AJR Am J Roentgenol 179:1059–1062

    Article  PubMed  Google Scholar 

  78. DeMatteo RP, Lewis JJ, Leung D, et al. (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231(1):51–58

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  79. Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G (2002) Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 33(5):466–477

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Many thanks to Megan Rojas for her contribution of the detailed medical illustrations in Figs. 1 and 2.

Author information

Authors and Affiliations

  1. Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St., New York, NY, 10065, USA

    Abbey J. Winant, Amar Vora & Douglas A. Brylka

  2. Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, 10065, USA

    Paula S. Ginter

  3. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Marc S. Levine

Authors
  1. Abbey J. Winant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amar Vora
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula S. Ginter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc S. Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas A. Brylka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas A. Brylka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Winant, A.J., Vora, A., Ginter, P.S. et al. More than just metastases: a practical approach to solid mesenteric masses. Abdom Imaging 39, 605–621 (2014). https://doi.org/10.1007/s00261-014-0090-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0090-4

Keywords

Search

Navigation