P0239 - A Rare Case of Follicular Lymphoma Masquerading as Mesenteric Panniculitis

Rajarajeshwari Ramachandran, MD¹, Tyler Grantham, MD², Vikash Kumar, MD¹, Heidi Budke, MD³, Madhavi Reddy, MD¹, Vinaya Gaduputi, MD^3
1Brooklyn Hospital Center, Brooklyn, NY; ²Staten Island University Hospital, Staten Island, NY; ³Blanchard Valley Health System, Findlay, OH

Introduction: Mesenteric panniculitis affects the adipose tissue of the mesentery and is characterized by idiopathic inflammatory and fibrotic changes. Studies have identified an association between mesenteric panniculitis and malignancy, particularly lymphoma. We are reporting a 66-year-old woman who was first diagnosed with mesenteric panniculitis, followed by follicular lymphoma, six months later.

Case Description/Methods: A 66-year-old woman presented for evaluation of left lower quadrant abdominal pain and unintentional weight loss of 30 pounds. She denied fevers, chills, night sweats, nausea, vomiting, melena or hematochezia. Patient underwent computed tomography of abdomen and pelvis for evaluation of abdominal pain and fat stranding in the mesentery suggestive of mesenteric panniculitis was identified (image A). Given the unintentional weight loss, she underwent esophagogastroduodenoscopy and colonoscopy and no pathology was identified. Patient’s abdominal pain secondary to panniculitis resolved with use of non-steroidal anti-inflammatory drugs.



Six months later, she underwent cholecystectomy for symptomatic gallstones and the resected gallbladder specimen demonstrated chronic cholecystitis, and lymph nodes showed neoplastic follicles containing small lymphocytes (image B). Immunohistochemical staining of the lymphocytes were strongly positive for CD10, CD20, CD23 and bcl-2 consistent with low grade follicular lymphoma.

Discussion: Lymph node size more than 12 mm and the absence of the fat ring sign have been identified as predictors of subsequent diagnosis of malignancy in patients with mesenteric panniculitis. The most common malignancy identified with mesenteric panniculitis is non-Hodgkin lymphoma. Mesenteric panniculitis most likely represents a paraneoplastic phenomena, rather than a precursor to malignancy.



Disclosures:


Rajarajeshwari Ramachandran, MD¹, Tyler Grantham, MD², Vikash Kumar, MD¹, Heidi Budke, MD³, Madhavi Reddy, MD¹, Vinaya Gaduputi, MD³. P0239 - A Rare Case of Follicular Lymphoma Masquerading as Mesenteric Panniculitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.