Abstract | AIMS:
Mesenteric panniculitis (MP), sclerotic mesenteritis (SM) and mesenteric lipodystrophy (ML) are the three histopathological forms of a rare inflammatory mesenteric disease. The pathogenesis is unknown until now. Hypothesis of a dysimmune disorder is advocated. Our purpose was to find histological basis to assert this hypothesis. MATERIAL AND METHODS: All patients with a diagnosis of inflammatory mesenteric disease made in Beaujon hospital were selected. A histological study and a systematic immunostaining with IgG4, CD3 and CD8 antibodies were performed for each patient with paraffin block available. Dysimmune features were defined by: a plasma cells component >30 %, an eosinophilic polynuclears component >10 %, a rate TCD8/CD3 >30 % and IgG4+ plasma cells >30/high power field (x400). Cases were classified in 3 forms on the basis of the predominant component: MP (lymphoid/plasma cell infiltrate), SM ( fibrosis), ML ( fat necrosis). RESULTS: Thirteen patients (7 men, 6 women) were selected, with a mean age of 57 years (21-80 years); a paraffin block was available for 10 patients. The clinical and histological presentations were heterogeneous: a mesenteric mass was the most frequent mode of revelation (6/13 patients) and all histological forms were present (3 MP, 5 SM and 5 ML). Nine patients had surgical biopsy, 2 had a trephine biopsy and 2 a resection. Standard histological analysis showed numerous eosinophils (> or =10 %) and plasma cells (>30 %) in respectively 3 (23 %) and 6 (46 %) of the 13 cases. The immunohistochemistry (performed in 10 patients) showed numerous TCD8+ in 80 % of the cases and numerous IgG4+ plasma cells in only 31 % of the cases (4 cases) (IgG4+ >30/x400). CONCLUSIONS: Our results demonstrate that inflammatory mesenteric diseases are heterogeneous: high components of plasma cells, eosinophils and TCD8+ lymphocytes were found respectively in 46, 23 and 80 % of cases; eosinophils were observed exclusively in sclerotic forms. Only 31 % of cases encompass numerous IgG4+ plasma cells, suggesting a pathogenesis different than hyper-IgG4 diseases.
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Authors | Hicham Belghiti, Dominique Cazals-Hatem, Anne Couvelard, Nathalie Guedj, Pierre Bedossa |
Journal | Annales de pathologie
(Ann Pathol)
Vol. 29
Issue 6
Pg. 468-74
(Dec 2009)
ISSN: 0242-6498 [Print] France |
Vernacular Title | La mesentérite sclérosante est-elle une maladie dysimmunitaire à IgG4 ? |
PMID | 20005433
(Publication Type: Journal Article)
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Chemical References |
- Antibodies
- CD3 Complex
- CD8 Antigens
- Immunoglobulin G
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Topics |
- Adipose Tissue
(pathology)
- Adult
- Aged
- Aged, 80 and over
- Antibodies
(blood)
- Biopsy
- CD3 Complex
(analysis, immunology)
- CD8 Antigens
(immunology)
- Female
- Fibrosis
(immunology)
- Humans
- Immunoglobulin G
(blood)
- Immunohistochemistry
- Lymphocytes
(immunology, pathology)
- Male
- Middle Aged
- Necrosis
- Panniculitis, Peritoneal
(immunology, pathology, surgery)
- Plasma Cells
(immunology, pathology)
- Retrospective Studies
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