Mesenteric Lipodystrophy

The clinical presentation of 53 patients with mesenteric lipodystrophy was variable and nonspecific. Most characteristic was a left upper-quadrant abdominal mass in an older person with either no symptoms or vague abdominal distress. Laboratory and roentgenologic findings were not helpful, and diagnosis was made by laparotomy. At surgery the disease presented as diffuse mesenteric thickening (42%), a single discrete tumor (32%), or multiple tumors (26%). Microscopically, there were altered lipocytes and fat-laden macrophages with little inflammatory reaction or fibrosis, suggesting a degenerative process of the fat rather than a true panniculitis. The course of the untreated disease was usually benign. The commonest outcome was spontaneous relief of symptoms; in some patients the disease had completely disappeared at subsequent abdominal operation. No treatment was of proved benefit. Eight patients (15%) also were found to have malignant lymphomas. The nature of this association remains unexplained.