Woman with chronic constipation.

Our appreciation is extended to Dr. Bobby Oberle, Indiana University Department of Radiology, for contributing this case.

Woman with chronic constipation.

Woman with chronic constipation.

• Gastrointestinal stromal tumor
• Desmoid tumor
• Lymphoma
• Sarcoma
• Metastasis
• Sclerosing mesenteritis

Woman with chronic constipation.

• The mesentery is a common pathway of malignant tumor spread via 4 major mechanisms:
  • Direct spread along mesenteric vessels and fat (DDX: GI carcinoid vs. gastric, pancreatic, biliary, or colon cancer)
  • Lymphatic spread (Lymphoma >> colon, ovarian, breast, or lung cancer, melanoma, carcinoid)
  • Hematogenous embolic spread (Melanoma, breast, lung cancer)
  • Intraperitoneal seeding (Breast, gastric, pancreatic, or ovarian cancer, mesothelioma, primary GI lymphoma, TB)
• Primary mesenteric tumors (e.g., desmoid) are quite rare. In a series of 101 patients with mesenteric masses by Whitley, all but 1 were metastatic.
• Lymphoma is the most common malignant neoplasm involving the mesentery.
• Approximately 30-50% of NHL patients harbor mesenteric nodal disease.
• Commonly presents as multiple large, rounded, mildly enhancing mesenteric masses.
• May encase mesenteric vessels, producing a "sandwich" sign.
• May present as large, lobulated, "cakelike" mass. Often displaces mesenteric vessels.
• Retroperitoneal lymphadenopathy seen along with mesenteric mass provides a clue to the diagnosis of lymphoma.

1. Federle, MP. Retroperitoneal and Mesenteric Lymphoma. https://my.statdx.com.
2. Sheth S, et al. Mesenteric Neoplasms: CT Appearances of Primary and Secondary Tumors and Differential Diagnosis. Radiographics 2003; 23: 457-73.
3. Whitley NO, et al. CT Patterns of Mesenteric Disease. Journal of Computed Assisted Tomography 1982; 6(3): 490-96.

Woman with chronic constipation.