MEETING No. 39, FEBRUARY 13th, NATIONAL CANCER INSTITUTE, MILANO

Case 1
Case 2
Case 3
Case 4

Case 1


"MESENTERIC MASS"
A. PELLEGRINELLI - I.N.T. Milano
(pictures by dr. Giardini)

Clinical history: a56y.o. woman with no significant past clinical history, presents with diffuse abdominal pain, asthenia and 15kgs weight loss since a few months. A CT scan shows a diffuse thickening of the mesentery and of the wall of the left colon. A pan-colonoscopy is performed and shows oedematous and congested mucosa: the performed biopsies confirm the endoscopy features of edema and chronic inflammation of the colonic mucosa.
A clinical diagnosis of lymphoma is done and an explorative laparoscopy is performed with possible left colectomy considered: during surgery two frozen intra-operative biopsies show steatonecrosis and chronic inflammation.
Macroscopical description: left colon with marked thickening of the mesocolon and of the epiploic appendages; the peritoneum shows no relevant macroscopical alterations and on opening the colonic mucosa is oedematous with focal sub-stenosis of the lumen. On cut section the epiploic appendages show lobular yellowish nodules, with thickened walled blood vessels; the wall of the colon doesn't appear involved.
Microscopical description: The morphological features of the mucosa confirm those of the biopsies with edema and chronic inflammation (Foto 1); in the submucosa there are numerous dilated blood vessels (Foto 2); in the mesentery and in the epiploic appendages there is a lobular infiltrate which consists of lipophagic histiocytes, plasma cells and lymphocytes and is associated with a reactive fibroblastic proliferation (Foto 3 - Foto 4 - Foto 5 - Foto 6).
The examined lymph nodes are free from neoplasia.

Diagnosis

Foto 1	Foto 2
Foto 3	Foto 4
Foto 5	Foto 6

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