Sclerosing mesenteritis involving the pancreas: two cases of a rare cause of abdominal mass mimicking malignancy

Two patients presented with abdominal pain and weight loss and each was fou nd to have an abdominal mass involving the pancreas and small bowel mesente ry. In both cases a malignant process was suspected clinically, radiologica lly and surgically. Multiple biopsy specimens in both patients showed dense fibrosis, chronic inflammation and fat necrosis with pancreatic infiltrati on. Histological opinions included the differential diagnosis of retroperit oneal fibrosis but, with the knowledge of the presence of localized masses, these cases were eventually considered to be due to sclerosing mesenteriti s. Direct involvement of the pancreas has not previously been highlighted a nd led to diagnostic difficulty. Both patients have responded to treatment with corticosteroids, interestingly, one of the patients subsequently devel oped a tubulo-interstitial nephritis, which has not previously been reporte d as associated with sclerosing mesenteritis, This has also responded to co rticosteroid treatment. Eur J Gastroenterol Hepatol 11:1323-1329 (C) 1999 L ippincott Williams & Wilkins.