Mesenteric panniculitis accompanying with sweet’s syndrome: case report

Schwannoma is a benign tumor arising from the sheath of peripheral nerves. It occurs predominantly in head and neck (45%), extremities (33%) and retroperitoneal space (0.7%). Schwannomausually occurs in young to middle-aged adults, more prevalently in women, and is rare in old man, not to mention that arising from the mesentery. Herein, we report a case of ancient schwannoma arising from the mesentery which gradually increased over the period of 10 years in an aged male patient. A 79-year-old man with a history of common bile duct (CBD) stone was admitted for evaluation of jaundice and abdominal pain. Liver function enzyme was elevated in a cholestatic pattern and computed tomography (CT) scan showed CBD stone recurrence. Therefore, endoscopic retrograde cholangiopancreatography was performed to resolve biliary obstruction. In addition to the CBD stones, a 8.9 cm sized heterogeneously enhancing mass lesion abutting jejunal mesentery and involving jejunal branches of superior mesenteric artery was noted. On retrospective review of the CT scan taken 10 years ago at the time of CBD stone removal, a 3 cm sized mass lesion abutting jejunum was found to have been present. Percutaneous biopsy performed at that time showed proliferation of spindle cells. Although surgical resection had been recommended, the patient was lost to follow-up. Since the size of the mass has increased up to nearly 3 folds on follow-up CT scan, albeit over the period of 10years, surgical resection was performed. The tumor was composed of oval to spindle cells and the tumor cells were positive for S-100 but negative for CD 34. Ki-67 index was less than 5 percent. Based on these histopathologic and immunohistochemical examination, the patient was diagnosed with benign mesenteric ancient schwannoma. Intraabdominal schwannoma is usually identified incidentally by imaging studies such as CT scans. And it is difficult to make a proper diagnosis due to lack of specific radiologic characteristics. Treatment of choice is complete surgical resection, because malignancy cannot be excluded. Based on the limited number of literature reporting mesenteric schwannoma, recurrence or malignant transformation after complete resection is very rare.