Focal myointimal hyperplasia of mesenteric veins is associated with previous trauma in surgical specimens

Sherman, Jessica F.; Kao, Patricia C; West, A. Brian; Blaszyk, Hagen

doi:10.1016/j.prp.2006.03.003

Cited by 18 publications

(11 citation statements)

References 10 publications

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“…[ 22 ] The pre-operative diagnosis of focal lesions was challenging. Sherman et al [ 23 ] reported that focal myointimal hyperplasia of mesenteric veins were associated with pre-resection trauma to the involved bowel segment. Thus, we need to be differentiated from colon cancer combining the clinical history and serum tumor markers.…”

Section: Discussionmentioning

confidence: 99%

Radiological and clinical findings of idiopathic myointimal hyperplasia of mesenteric veins

Xie¹,

Xu²

2021

Medicine

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Introduction: Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is an uncommon cause of ischemic bowel disease resulting from the proliferation of smooth muscles in the venous intima. Delayed diagnosis could only be made following the surgical resection due to lack of imaging data, which may lead to bowel severe bleeding, perforation, necrosis, infection, or shock. In previous reports, few cases have provided the detailed pre-operative radiological characteristics of IMHMV. Herein, we are the first to provide the complete clinical course and comprehensive pre-operative radiological data of a 21-year-old female diagnosed with IMHMV. Patient concerns: A 21-year-old female was admitted to our hospital with bloody diarrhea and abdominal pain. Physical examination revealed tenderness localized to the left lower abdomen. The patient had no prior history of similar symptoms. A computed tomography scan was performed and showed diffuse wall thickening from the rectum to sigmoid colon with poor mural enhancement, multiple ulcers, fat stranding, and free fluid. The arterial phase images demonstrated many tortuous pericolic arteries and submucosal pseudoaneurysm. Intervention: Conservative treatment including empirical antibiotics, Mesalazine, and methylprednisolone sodium succinate were administrated to relief the symptoms. However, the diarrhea and abdominal pain worsened. An emergency surgery was arranged and total proctocolectomy with ileal pouchanal anastomosis with ileostomy was performed. Diagnosis: Macroscopic and histopathological examinations of the excised specimen showed ischemic colitis. Elastica van Gieson staining revealed extensive myointimal hyperplasia and confirmed the diagnosis of IMHMV. Outcomes: During the 2-year follow-up period, no additional medical management was needed. The patient was well and surveillance colonoscopy showed normal colon and anastomosis. Conclusion: Pre-operative computed tomography with imaging features including pronounced continuous concentric thickening colonic wall with poor enhancement and enlarged tortuous pericolic arteries could specifically facilitate the speedy diagnosis of IMHMV.

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Section: Discussionmentioning

confidence: 99%

Radiological and clinical findings of idiopathic myointimal hyperplasia of mesenteric veins

Xie¹,

Xu²

2021

Medicine

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“…The first case of jejunal involvement showed only one vein rather than multiple with eccentric luminal occlusion by what looks like inflamed organized thrombus rather than fibromxyoid spindle cell proliferation in the intima. Sherman and colleagues have highlighted that small focal lesions in mesenteric veins resembling IMHMV but distinct from the more diffuse lesions in classical IMHMV can be found in bowel associated with preresection healed trauma, including volvulus, intussusception, incarcerated hernia; stoma takedown; or anastomoses in the involved bowel segment, as well as colonic resections for diverticulitis and inflammatory bowel disease. Kao et al .…”

Section: Discussionmentioning

confidence: 99%

Idiopathic myointimal hyperplasia of the mesenteric veins: Case report and review of the literature

et al. 2019

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In 1991, Genta and Haggitt described four patients with segmental ischemic colitis caused by idiopathic myointimal hyperplasia in the small mesenteric veins (IMHMV). There are now 33 published cases of IMHMV in the literature; however, this condition is still sufficiently rare that it poses a diagnostic challenge to pathologists and clinicians and is often clinically or histologically confused with inflammatory bowel disease (IBD) or ischemic colitis. IMHMV is characterized by intimal smooth muscle hyperplasia resulting in thickened small and medium‐sized mesenteric veins (with arterial sparing). Clinically, it presents with symptoms that mimic IBD, such as bloody diarrhea, abdominal pain, and weight loss. Surgical resection appears to be curative. The present case describes a 63‐year‐old Vietnamese man with cardiovascular risk factors who was diagnosed with IMHMV after many months of severe symptoms. A review of the current literature follows the case report.

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“…The vessel abnormalities in IMHMV have been reported to resemble histologically failed saphenous vein grafts from patients that have undergone aortocoronary bypass surgery [ 18 ] as well as stenotic arteriovenous fistulas in dialysis patients [ 19 ], suggesting an “arterialization” of veins due to increased intraluminal pressure. Some have proposed that the mobility of the sigmoid colon renders it susceptible to traumatic injury secondary to torsion, volvulus, or stretch, leading to arteriovenous fistulization and ultimately myointimal hyperplasia of the mesenteric veins [ 18 , 20 ]. However, this mechanism fails to account for the occurrence of IMHMV in other parts of the bowel that lack such mobility and further investigation into the pathogenesis is needed.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Myointimal Hyperplasia of Mesenteric Veins of the Ileum and Colon in a Patient with Crohn’s Disease: A Case Report and Brief Review of the Literature

Song

Shroff

2017

Case Reports in Pathology

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Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare disease characterized by intimal smooth muscle proliferation, leading to the thickening of small to medium-sized mesenteric veins. This vascular disease mimics inflammatory bowel disease (IBD) clinically and endoscopically, while showing ischemic mucosal changes without the classic features of IBD on biopsy. Given the mixed picture, this entity is frequently misdiagnosed. Surgical resection of the diseased bowel segment reveals the true etiology of the pathology and is curative. We describe a case of a 59-year-old man with a long-standing history of Crohn's disease refractory to medical therapy and status after multiple small bowel resections. The patient underwent a subtotal abdominal colectomy with pathology showing dense, indurated mesenteric adipose tissue, significant muscularis propria hypertrophy, and myointimal hyperplasia of the mesenteric veins in a peri-ileal and pericolic distribution, as confirmed by elastin stain. No evidence of mucosal ischemic changes or findings of chronicity or acuity were seen. IMHMV, a rare disease with a mixed presentation, poses a significant diagnostic challenge to clinicians and pathologists.

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Focal myointimal hyperplasia of mesenteric veins is associated with previous trauma in surgical specimens

Cited by 18 publications

References 10 publications

Radiological and clinical findings of idiopathic myointimal hyperplasia of mesenteric veins

Radiological and clinical findings of idiopathic myointimal hyperplasia of mesenteric veins

Idiopathic myointimal hyperplasia of the mesenteric veins: Case report and review of the literature

Idiopathic Myointimal Hyperplasia of Mesenteric Veins of the Ileum and Colon in a Patient with Crohn’s Disease: A Case Report and Brief Review of the Literature

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