title: Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.
abstract: Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.
authors.affiliation: Department of Pathology, Royal Preston Hospital NHS Trust, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Howat
authors.forename: J L
authors.initials: JL
authors.lastname: McPhie
authors.forename: D A
authors.initials: DA
authors.lastname: Smith
authors.forename: N M
authors.initials: NM
authors.lastname: Aqel
authors.forename: A K
authors.initials: AK
authors.lastname: Taylor
authors.forename: S A
authors.initials: SA
authors.lastname: Cairns
authors.forename: W E
authors.initials: WE
authors.lastname: Thomas
authors.forename: J C
authors.initials: JC
authors.lastname: Underwood
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D008643:Mesentery; D010532:Peritoneal Diseases / Q000209:etiology / Q000473:pathology; D011379:Prognosis