Diagnostic and Interventional Imaging (2015) 96, 225—226
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EDITORIAL
Mesenteric panniculitis: More research is needed KEYWORDS Mesenteric panniculitis; Mesentery; CT; Neoplasia; Paraneoplastic
Mesenteric panniculitis (MP) is a rare, presumably benign, inflammatory condition that involves the adipose tissue of the mesentery [1]. Although several hypotheses have been suggested, the etiology of this non-specific condition has not been clearly elucidated yet. MP could be considered as an anecdotal finding because it is predominantly a clinically asymptomatic condition and the detection of MP is made incidentally on computed tomography (CT). After a retrospective analysis of 7620 CT examinations, Daskalogiannaki et al. reported that MP was found incidentally on CT in 91.8% of patients [2]. In addition, MP is a rare condition. In this regard, the same authors found MP in only 0.6% of patients who have undergone CT of the abdomen [2]. MP might have been considered as a negligible finding and this could have been the end of the story. However, the same authors have reported that in their cohort MP was associated with a known malignancy in 34 of the 49 patients with MP (69.4%). These malignancies have a wide range of primary location and were not exclusively abdominal or pelvic malignancies [2]. Following studies and anecdotal case reports have suggested an association between MP and neoplasia [3,4]. Wilkes et al. found an association between MP and neoplasia in 39% of 118 patients with MP [3]. More recently, van Putte-Katier et al. identified 94 patients with MP among 3820 consecutive patients who underwent CT examination [4]. MP coexisted with malignancy in 48.9% of their patients (especially prostatic carcinoma) by comparison with 46.3% in the control group. More interestingly, they found an increased incidence of cancer in the MP patients during a 5-year follow-up [4]. In this issue of Diagnostic and Interventional Imaging, Badet et al. have reported the results of their study that addressed this issue [5]. They found that 56% of patients with MP, as observed on CT, had a known neoplasia [5]. Of interest, neoplasias predominantly consisted of lymphoma (28% of patients with MP) and melanoma (18% of patients with MP). Unfortunately, the relationships or the association between PM and neoplasia is not so straightforward. By contrast with the results of the above-mentioned studies, Coulier et al. observed that only 33% of patients with MP had a known neoplasia whereas 67% did not [6]. Similarly, Gögebakan et al. reviewed 13 485 CT examinations for presence of MP. They found a prevalence of 0.58% for MP (77/13 485) and an association with neoplasia in 50.6% patients with MP whereas malignancy was present in 61.2% of patients with no MP [7].
http://dx.doi.org/10.1016/j.diii.2015.02.003 2211-5684/© 2015 Éditions franc ¸aises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
226 In this issue of the Journal, Badet et al. have investigated if a relationship can be found between MP, as observed on CT, and the presence of an underlying neoplastic disease [5]. They have conducted a retrospective analysis of clinical data and CT examinations of 158 patients with MP. They found an underlying neoplastic disease in 88/158 patients (56%). They concluded that their results should be considered as a step further for considering MP as a paraneoplastic condition. With their paper, Badet et al. have added important data to the existing knowledge regarding MP [5]. However, the story still goes on. There is no definite answer and the debate is still open. It may be reasonably assumed that most studies dealing with MP were affected by multiple biases, such as selection and inclusion bias due to local specificities of patients’ population and by variations in the actual definition of MP [1,8]. We thus suggest that future research regarding MP should take into account the following points. First, the diagnosis of MP on CT is based on an association of 3 or 5 criteria [6]. However, the CT diagnostic criteria used are not clearly described in most papers so that future studies should compare individual CT findings in MP patients with neoplasia with those in MP patients without neoplasia. Second, MP is probably a disease of the mesenteric fat and a control group should include patients matched for body mass index. Third, patients with MP should be followed-up to determine the incidence of newly developed cancers after MP has been revealed by CT by comparison with a control group matched for age and sex without MP. In our opinion, this should be the best study to be done.
Disclosure of interest The authors have not supplied their declaration of conflict of interest.
Editorial [2] Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, StefanakiK, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol 2000;174:427—31. [3] Wilkes A, Griffin N, Dixon L, Dobbs B, Frizelle FA. Mesenteric panniculitis: a paraneoplastic phenomenon? Dis Colon Rectum 2012;55:806—9. [4] Van Putte-Katier N, van Bommel EF, Elgersma OE, Hendriksz TR. Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up. Br J Radiol 2014;87(1044):20140451. [5] Badet N, Sailley N, Briquez C, Paquette B, Vuitton L, Delabrousse E. Mesenteric panniculitis: still an ambiguous condition? Diagn Interv Imaging 2015. [6] Coulier B. Mesenteric panniculitis. Part 2: prevalence and natural course: MDCT prospective study. JBR-BTR 2011;94: 241—6. [7] Gögebakan O, Albrecht T, Osterhoff MA, Reimann A. Is mesenteric panniculitis truely a paraneoplastic phenomenon? A matched pair analysis. Eur J Radiol 2013;82: 1853—9. [8] Filippone A, Cianci R, Di Fabio F, Storto ML. Misty mesentery: a pictorial review of multidetector-row CT findings. Radiol Med 2011;116:351—65.
P. Soyer (MD, PhD) a,∗,b , C. Hoeffel c,d , M. Zins e a
Department of Abdominal Imaging, hôpital Lariboisière, AP—HP, 2, rue Ambroise-Paré, 75010 Paris, France b Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France c Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France d Université de Reims Champagne-Ardennes, 51, rue Cognacq-Jay, 51100 Reims, France e Department of Radiology, fondation hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France ∗ Corresponding
References [1] Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 2003;23:1561—7.
author.
E-mail address: [email protected] (P. Soyer)
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
EDITORIAL
Mesenteric panniculitis: More research is needed KEYWORDS Mesenteric panniculitis; Mesentery; CT; Neoplasia; Paraneoplastic
Mesenteric panniculitis (MP) is a rare, presumably benign, inflammatory condition that involves the adipose tissue of the mesentery [1]. Although several hypotheses have been suggested, the etiology of this non-specific condition has not been clearly elucidated yet. MP could be considered as an anecdotal finding because it is predominantly a clinically asymptomatic condition and the detection of MP is made incidentally on computed tomography (CT). After a retrospective analysis of 7620 CT examinations, Daskalogiannaki et al. reported that MP was found incidentally on CT in 91.8% of patients [2]. In addition, MP is a rare condition. In this regard, the same authors found MP in only 0.6% of patients who have undergone CT of the abdomen [2]. MP might have been considered as a negligible finding and this could have been the end of the story. However, the same authors have reported that in their cohort MP was associated with a known malignancy in 34 of the 49 patients with MP (69.4%). These malignancies have a wide range of primary location and were not exclusively abdominal or pelvic malignancies [2]. Following studies and anecdotal case reports have suggested an association between MP and neoplasia [3,4]. Wilkes et al. found an association between MP and neoplasia in 39% of 118 patients with MP [3]. More recently, van Putte-Katier et al. identified 94 patients with MP among 3820 consecutive patients who underwent CT examination [4]. MP coexisted with malignancy in 48.9% of their patients (especially prostatic carcinoma) by comparison with 46.3% in the control group. More interestingly, they found an increased incidence of cancer in the MP patients during a 5-year follow-up [4]. In this issue of Diagnostic and Interventional Imaging, Badet et al. have reported the results of their study that addressed this issue [5]. They found that 56% of patients with MP, as observed on CT, had a known neoplasia [5]. Of interest, neoplasias predominantly consisted of lymphoma (28% of patients with MP) and melanoma (18% of patients with MP). Unfortunately, the relationships or the association between PM and neoplasia is not so straightforward. By contrast with the results of the above-mentioned studies, Coulier et al. observed that only 33% of patients with MP had a known neoplasia whereas 67% did not [6]. Similarly, Gögebakan et al. reviewed 13 485 CT examinations for presence of MP. They found a prevalence of 0.58% for MP (77/13 485) and an association with neoplasia in 50.6% patients with MP whereas malignancy was present in 61.2% of patients with no MP [7].
http://dx.doi.org/10.1016/j.diii.2015.02.003 2211-5684/© 2015 Éditions franc ¸aises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
226 In this issue of the Journal, Badet et al. have investigated if a relationship can be found between MP, as observed on CT, and the presence of an underlying neoplastic disease [5]. They have conducted a retrospective analysis of clinical data and CT examinations of 158 patients with MP. They found an underlying neoplastic disease in 88/158 patients (56%). They concluded that their results should be considered as a step further for considering MP as a paraneoplastic condition. With their paper, Badet et al. have added important data to the existing knowledge regarding MP [5]. However, the story still goes on. There is no definite answer and the debate is still open. It may be reasonably assumed that most studies dealing with MP were affected by multiple biases, such as selection and inclusion bias due to local specificities of patients’ population and by variations in the actual definition of MP [1,8]. We thus suggest that future research regarding MP should take into account the following points. First, the diagnosis of MP on CT is based on an association of 3 or 5 criteria [6]. However, the CT diagnostic criteria used are not clearly described in most papers so that future studies should compare individual CT findings in MP patients with neoplasia with those in MP patients without neoplasia. Second, MP is probably a disease of the mesenteric fat and a control group should include patients matched for body mass index. Third, patients with MP should be followed-up to determine the incidence of newly developed cancers after MP has been revealed by CT by comparison with a control group matched for age and sex without MP. In our opinion, this should be the best study to be done.
Disclosure of interest The authors have not supplied their declaration of conflict of interest.
Editorial [2] Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, StefanakiK, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol 2000;174:427—31. [3] Wilkes A, Griffin N, Dixon L, Dobbs B, Frizelle FA. Mesenteric panniculitis: a paraneoplastic phenomenon? Dis Colon Rectum 2012;55:806—9. [4] Van Putte-Katier N, van Bommel EF, Elgersma OE, Hendriksz TR. Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up. Br J Radiol 2014;87(1044):20140451. [5] Badet N, Sailley N, Briquez C, Paquette B, Vuitton L, Delabrousse E. Mesenteric panniculitis: still an ambiguous condition? Diagn Interv Imaging 2015. [6] Coulier B. Mesenteric panniculitis. Part 2: prevalence and natural course: MDCT prospective study. JBR-BTR 2011;94: 241—6. [7] Gögebakan O, Albrecht T, Osterhoff MA, Reimann A. Is mesenteric panniculitis truely a paraneoplastic phenomenon? A matched pair analysis. Eur J Radiol 2013;82: 1853—9. [8] Filippone A, Cianci R, Di Fabio F, Storto ML. Misty mesentery: a pictorial review of multidetector-row CT findings. Radiol Med 2011;116:351—65.
P. Soyer (MD, PhD) a,∗,b , C. Hoeffel c,d , M. Zins e a
Department of Abdominal Imaging, hôpital Lariboisière, AP—HP, 2, rue Ambroise-Paré, 75010 Paris, France b Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France c Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France d Université de Reims Champagne-Ardennes, 51, rue Cognacq-Jay, 51100 Reims, France e Department of Radiology, fondation hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France ∗ Corresponding
References [1] Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 2003;23:1561—7.
author.
E-mail address: [email protected] (P. Soyer)
