title: IgG4-related sclerosing mesenteritis causing bowel obstruction: a case report.
abstract: Sclerosing mesenteritis (SM) is a rare inflammatory and fibrosing disease primarily involving the small-bowel mesentery. Recently, SM was reported to be closely related to IgG4-related disease (IgG4-RD). This report describes a patient with SM associated with IgG4-RD. A 77-year-old woman with a history of surgery for ectopic pregnancy and wound dehiscence presented with intestinal obstruction. Abdominal enhanced computed tomography (CT) revealed an enhanced, radially shaped, oval mass, 3 cm in diameter, with an unclear rim in the mesentery of the distal ileum, which may have involved the distal ileum. To remove the cause of bowel obstruction, the SM was resected completely and the ileum was resected partially. Histologic examination showed that the mass was composed of spindle cells arranged in a fascicular or storiform pattern; moreover, fibrous stroma was observed, with dense lymphoplasmacytic infiltration and lymphoid follicles. Immunohistochemically, numerous IgG4-positive plasma cells were observed, at a density of 253 per high-powered field, and the IgG4/IgG ratio was about 50 %. Elastica van Gieson (EVG) staining also showed obstructive phlebitis. These findings indicated IgG4-related SM. Although the accurate diagnosis of SM remains difficult without histological analysis, IgG4-RD should be included in the differential diagnosis of unknown mesenteric tumors. Identification of IgG4-RD may prevent unnecessary surgery because corticosteroids may be effective in these patients.
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. a-abe@surg1.med.kyushu-u.ac.jp.|Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan. a-abe@surg1.med.kyushu-u.ac.jp.
authors: Atsushi
authors: http://orcid.org/0000-0003-3546-2128
authors: A
authors: Abe
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Tatsuya
authors: T
authors: Manabe
authors: Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
authors: Nobuyoshi
authors: N
authors: Takizawa
authors: Department of Surgery, Hamanomachi Hospital, Fukuoka, 810-8539, Japan.
authors: Takashi
authors: T
authors: Ueki
authors: Department of Surgery, Japan Community Health Care Organization, Kyushu Hospital, Fukuoka, 806-8501, Japan.
authors: Daisuke
authors: D
authors: Yamada
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Kinuko
authors: K
authors: Nagayoshi
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Yoshihiko
authors: Y
authors: Sadakari
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Hayato
authors: H
authors: Fujita
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Shuntaro
authors: S
authors: Nagai
authors: Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
authors: Hidetaka
authors: H
authors: Yamamoto
authors: Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
authors: Yoshinao
authors: Y
authors: Oda
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Masafumi
authors: M
authors: Nakamura
keywords: IgG4-related SM; Intestinal obstruction; Sclerosing mesenteritis