Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.
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.
Howat
A J
AJ
Department of Pathology, Royal Preston Hospital NHS Trust, UK.
McPhie
J L
JL
Smith
D A
DA
Aqel
N M
NM
Taylor
A K
AK
Cairns
S A
SA
Thomas
W E
WE
Underwood
J C
JC
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