Tumours of the mesentery

Tumours of the mesentery

Primary tumours of the mesentery include carcinoid, lymphoma, sarcoma and desmoid tumours. The mesentery is a ff ected in local lymphatic spread of carcinoma arising from abdominal viscera ( Figure 65.17 ). If indicated, a benign tumour of the mesentery may be excised with resection of the adjacent intestine. A malignant tumour of the mesentery requires biopsy confirmation and specific, usually non-surgical, treatment, e.g. chemotherapy for lymphoma. Diffuse fibromatosis Fibromatosis is rare, characterised by an abnormal prolifer ation of myofibroblasts. Although non-metastasising, and said to be benign, it can nevertheless prove widely invasive, Mesenteric cysts: clinical features /uni25CF /uni25CF /uni25CF /uni00A0 /uni25CF /uni25CF /uni25CF /uni25CF ). An /uni25CF /uni25CF /uni25CF /uni25CF compressing and infiltrating surrounding tissues such as the bowel and mesentery with complications thereof. There is an association with familial adenomatous polyposis (FAP). Summary box 65.10 Mesenteric tumours /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF

(a) Figure 65.17 Terminal ileal carcinoid (a) and lymphatic metastasis (b) . (Reproduced with permission from Coffey JC, Lavery I, Sehgal R (eds). Mesenteric principles of gastrointestinal surgery: basic Carcinoid and applied principles . Boca tumour Raton: CRC Press, 2017: 85–108.) Cysts occur most commonly in adults with a mean age of 45 years Twice as common in women as in men Rare: incidence around 1 per 140 000 Approximately a third of cases occur in children younger than 15 years The mean age of children affected is 5 years The most common presentation is of a painless /f_l uctuant abdominal swelling near the umbilicus Other presentations are with recurrent attacks of abdominal pain with or without vomiting (pain resulting from recurring temporary impaction of a food bolus in a segment of bowel narrowed by the cyst or possibly from torsion of the mesentery) and acute abdominal catastrophe due to: torsion of that portion of the mesentery containing the cyst rupture of the cyst, often as a result of a comparatively trivial accident haemorrhage into the cyst infection Benign Malignant Lipoma Lymphoma Fibroma Secondary carcinoma Fibromyxoma Neuroendocrine tumours Desmoid Lymphatic metastases Tumour deposits (lymphovascular and perineural) Peritoneal carcinomatosis Mesoileum (b) Mesenteric Terminal lymphatic ileum metastasis

Ileocaecal mesentery Mesoappendix Figure 65.18 The mesoappendix. (Reproduced with permission from Coffey JC, Lavery I, Sehgal R (eds). surgery: basic and applied principles . Boca Raton: CRC Press, 2017: 11–40.)