Mesenteric panniculitis: is it really associated with cancer? A retrospective imaging-based study

Abstract

Background

The link between mesenteric panniculitis (MP) and cancer is debated. We explored this association after adjusting for age.

Materials & Methods

We retrospectively analyzed abdominal CT scans of 8,750 patients between 2015 and 2017. Patients were categorized by cancer status.

Results

Of included patients, 8.7% had cancer. MP was found in 148 patients (58% males, mean age 57.8 years). MP was more frequent in cancer patients (5.14%) compared to no-cancer group (1.36%). Among MP patients, breast cancer was the most common malignancy. After adjusting for age, MP remained significantly associated with breast cancer and multiple myeloma in females and lymphoma in males.

Conclusion

MP was significantly associated with breast cancer and multiple myeloma in females and lymphoma in males.

PLAIN LANGUAGE SUMMARY

Our study investigated the connection between mesenteric panniculitis (MP), a fatty tissue inflammation in the abdomen, and cancer. We looked at CT scan data from 8,750 patients. The results showed that MP was more common in people with cancer than those without it. Even after accounting for age, the link between MP and certain cancers was still strong. Particularly, MP was associated with breast cancer and multiple myeloma in women, and lymphoma in men.

ARTICLE HIGHLIGHTS

• Mesenteric panniculitis (MP) is a chronic inflammatory disease affecting the mesenteric adipose tissue of the small intestine.

• Diagnosis of MP is often incidental through CT scans with characteristic findings.

• The relationship between MP and malignancy remains controversial due to confounding factors.

• This large-scale study established a 1.7% prevalence of MP among investigated patients.

• Co-occurrence of MP and cancer was identified in 21.6% of MP cases.

• The study revealed a gender-specific association between MP and certain cancers: lymphoma in males and breast cancer, multiple myeloma in females.

• Age emerged as a significant independent risk factor for MP development.

• This study highlights the need for further investigation into the specific associations between MP and various malignancies stratified by gender.

1. Introduction

Mesenteric panniculitis is a long-lasting inflammatory condition affecting the mesentery of the small intestine [1,2]. The disease presents in three different manifestations: degeneration of the mesenteric fat (mesenteric lipodystrophy), an inflammatory response (mesenteric panniculitis [MP]), and the formation of fibrous tissue in the adipose tissue (retractile mesenteritis) [3].

Radiologically, MP is characterized by persistent inflammation in the mesentery of the small intestine, along with a fatty mass containing small lymph nodes and blood vessels surrounded by a pseudo capsule. MP is a condition that often goes undiagnosed, and its epidemiology remains not fully comprehended [4]. The reported prevalence of MP, as determined through computed tomography (CT) scans, varies between 0.16% and 7.8% [5–8].

The pathophysiology of MP has been linked to several hypotheses, with multiple reported etiologies of the disease. Historically, Kipfer et al. study in 1974 observed that among patients with MP in their study, 30% of them had an associated malignancy, with lymphoma being the most frequently identified neoplasm [9]. After that, similar findings have been reported by numerous studies estimating the prevalence of malignancy in MP cases to range from 17% to 38% in case-screening series lacking matched control groups [10,11]. However, in a more recent case-control study, they revealed that the likelihood of detecting a neoplasm in patients with MP does not increase when cases are matched with controls for factors such as age, sex, abdominal diameter, and CT protocol, which concludes MP not to be a paraneoplastic phenomenon [12].

The exact cause of MP remains uncertain, although potential factors include surgical procedures or injury, autoimmune disorders, infarction, infections, and paraneoplastic conditions [5,7,13]. MP predominantly affects middle-aged males and reaches its highest occurrence around the age of 60 years. The relationship between MP and cancer is a subject of debate, with reported prevalence rates among cancer patients ranging from 17% to 75% [5–7,9,14]. Lymphoma has been previously identified as the most frequently observed malignancy associated with MP [5,7,13,15].

The majority of MP cases are detected as an incidental finding during CT scans, and patients often do not exhibit any symptoms. However, some patients may experience nonspecific symptoms such as abdominal pain, fluctuations in weight, diarrhea, and fever, or symptoms related to underlying conditions, particularly cancer [1,5,6,13,14,16].

MP is diagnosed through the identification of characteristic CT features. These include the presence of a well-defined mass consisting of adipose tissue, exhibiting higher attenuation values compared to retroperitoneal fat, situated at the mesentery’s root. Additionally, the fatty tissue contains blood vessels and small lymph nodes, without any signs of vascular involvement or invasion of neighboring bowel loops [4].

The management of MP is typically spontaneous resolution in most cases. However, in patients with palpable masses, they may persist or reappear frequently, particularly between 2 and 11 years after diagnosis, especially in patients with comorbidities [17]. In these patients, there are various treatment options have been proposed. However, there are no standardized approach yet for the management of MP. But in general, the treatment is reserved for symptomatic cases, while incidental masses are often observed without intervention [18]. Management is tailored to the individual patient, with therapeutic options including medications such as steroids, thalidomide, cyclophosphamide, progesterone, colchicine, azathioprine, tamoxifen, antibiotics, and emetine, as well as radiotherapy, all of which have shown varying levels of effectiveness. Surgical intervention may be considered if medical therapy proves ineffective or if life-threatening complications arise, such as bowel obstruction or perforation [1,19].

The association between MP and cancer presents contradictory findings, and the relationship between MP and specific types of cancer remains unexplored. Additionally, MP and cancer often coincide within the same age group, making it challenging to ascertain which condition preceded the other in the absence of long-term chronological follow-up studies. To address this, the purpose of this study was to investigate the incidence of MP in CT-screened patients and its association with cancer, adjusting for age to establish a reliable association between MP and various cancers.

2. Materials and methods

2.1. Patients and study design

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki. The institutional review board of our center approved the study protocol (Approval No. 101–2018) and waived the need for informed consent, as the study involved minimal risk to patients and used anonymized clinical data.

This study included subjects who underwent abdominal and pelvic computed tomography (CT) imaging at our center between August 2015 and July 2017, and the desired regions of interest (abdomen and pelvis) were included in the imaging field. The selection of this time frame ensured that a comprehensive and consistent imaging database was available. Clinical data from 8750 patients who had CT imaging of the abdomen and pelvis were retrieved from the hospital information system and picture archiving and communication system (PACS). Data on patients with malignancies were retrieved from the electronic oncology database, and data on the types of malignancies were obtained from histopathology reports. Patients’ demographic and clinical data included age, sex, comorbidities, symptoms, and clinical diagnosis.

Patients with MP were identified from the electronic radiology records using the term “mesenteric panniculitis”. The inclusion criterion was CT evidence of MP confirmed by the radiologists. The exclusion criteria were ascites, liver cirrhosis, mesenteric congestion, and ischemia, to avoid obscuring mesenteric imaging findings.

2.2. Imaging methods

Abdomino-pelvic multi-slice CT scans were performed using a 64-slice CT scanner (Brilliance 64, Philips Healthcare, Best, Netherlands). Most scans were performed following oral or intravenous administration of contrast media. Patients with suspected urinary stones and patients with contraindications to iodinated contrast media underwent plain CT. Patients were scanned in the arterial or venous phase according to our institution’s protocol, depending on the clinical indication. Scout images of the abdomen and pelvis were acquired from the base of the lungs to the level of the symphysis pubis. Collimation was 64 mm × 0.625 mm, gantry rotation time was 350 ms, tube current was 200–300 mA, and voltage was 120–140 kV. For patients with evidence of MP, CT images were reconstructed and reviewed at a window suitable for abdominal analysis. When available, PET-CT scans were also evaluated.

All scans were reviewed by two experienced radiologists blinded to patient clinical information. Images were analyzed in a PACS workstation (Fuji, Japan) on axial, coronal, and sagittal planes [20].

MP was diagnosed according to Coulier abdominal CT criteria for mesenteric panniculitis if at least three of the following CT signs were present (Figure 1):

Figure 1.

Computed tomography signs of mesenteric panniculitis: A) Well-defined mesenteric fat tissue causing mass effect on adjacent organs, B) Mass with a density higher than adjacent peritoneal fat, C) Fat mass containing small lymph nodes and blood vessels, D) A halo sign or fat string sign around lymph nodes and blood vessels, E) Hyperattenuating pseudocapsule.

Figure 2.

Flowchart of patient selection. MP: mesenteric panniculitis.

1. Well-defined mesenteric fat tissue causing mass effect on adjacent organs.

2. Mass with a density higher than adjacent peritoneal fat

3. Fat mass containing small lymph nodes and blood vessels.

4. A halo sign or fat string sign around lymph nodes and blood vessels

5. Hyperattenuating Pseudocapsule

2.3. Statistical analysis

All analyses were performed using SPSS version 12.1 (SPSS Inc., Chicago, IL, USA). Descriptive and inferential statistics were used for statistical analysis. Categorical variables were described as frequencies (%), and odds ratios (ORs). Categorical variables were compared using the chi-squared test, and continuous variables were compared using Mann-Whitney U test (Wilcoxon Rank). Univariable analysis was performed to identify potential risk factors for malignancy among MP patients, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. All statistical tests were two-tailed. To ensure robustness of the results, data integrity was verified through a double-entry method, and discrepancies were resolved through consensus among researchers. Risk factors for malignancy in patients with MP were identified by univariable analysis. Statistical significance was set at p < 0.05.

3. Results

3.1. Clinical findings

A total of 8750 abdominal CT scans were performed during the study period, of which 759 patients had malignancies (8.7%), and 7991 patients had no evidence of malignancy (91.3%). MP was identified in 148 patients, 87 were males (58.8%) and 61 were females (41.2%). Mean age was 47.3 (18.8) in the MP-negative group, and 57.8 (13.7) in the MP-positive group.

Among the 148 MP-positive patients, 39(26.4%) were diagnosed with cancer, including 9 (6.1%) patients with breast cancer, 8 (5.4%) patients with lymphoma, 6 (4.1%) patients with colorectal cancer (CRC), 3 (2%) patients with lung cancer, 2 (1.4%) patients with prostate cancer, 2 (1.4) patients with bladder cancer, 2 (1.4%) patients with pancreatic cancer, 2 (1.4%) patients with multiple myeloma, and single cases of endometrium cancer, fibrosarcoma, ovarian cancer, chronic myeloid leukemia (CML), and carcinoid cancer. as shown in Table 1. The most common tumor associated with MP was breast cancer (6.1%) (Figure 3A). However, when assessing the prevalence of MP within individual cancer groups, lymphoma patients showed the highest proportion (6.56% of all lymphoma cases) (Table 2). The remaining 109(78%) MP-positive patients had no malignancy. Across all patients, MP-positive cases were older than MP-negative cases (Figure 3B). (Mean: 57.8 vs. 47; p-value < 0.0001).

Table 1.

Prevalence of cancers in patients with mesenteric panniculitis.

Type of cancer	Number of MP-positive patients	Prevalence (number of MP-positive patients / 148)
Breast	9	6.1
Lymphoma	8	5.4
Colorectal	6	4.1
Lung	3	2.0
Prostate	2	1.4
Bladder	2	1.4
Pancreas	2	1.4
Multiple myeloma	2	1.4
Ovarian	1	0.7
Carcinoid	1	0.7
CML	1	0.7
Fibrosarcoma	1	0.7
Endometrial	1	0.7
Total	39	26.4

MP, mesenteric panniculitis.

Figure 3.

A) Bar plot illustrating the frequencies of tumors among MP-positive cases. Breast cancer demonstrates highest frequency followed by lymphoma and colorectal cancer (CRC). B) Boxplot showing higher age was significantly associated with positive-MP cases.

Table 2.

Prevalence of mesenteric panniculitis according to the type of cancer.

Type of cancer	Number of patients	MP-positive cases	Prevalence
Breast	238	9	3.8%
Colorectal	222	6	2.7%
Lymphoma	122	8	6.6%
Others	177	16	9.0%
Total	759	39	5.1%

MP, mesenteric panniculitis.

Within the MP-positive cases, a significant association was found between higher prevalence of lymphoma in males (OR: 3.6 [1.27–10.19], p-value = 0.016) with no significant association in females (Table 3). While breast cancer showed significant association with females (OR: 3.04 [1.46–6.34], p-value < 0.01). Multiple myeloma was also significantly associated with females (OR: 14.7 [1.67–129.2], p-value = 0.015).

Table 3.

Regression model of cancer association with MP.

Variable	Females				Males
	Or	LL	UL	p-value	Or	LL	UL	p-value
No cancer	1				1
Breast cancer	3.04	1.46	6.34	0.003*	NA	NA	NA	NA
Colorectal cancer	1.07	0.25	4.51	0.924	1.16	0.36	3.79	0.802
Lymphoma	1.49	0.20	11.17	0.699	3.60	1.27	10.19	0.016*
Other cancers	3.18	0.95	10.72	0.062	0.50	0.07	3.65	0.494
Pancreatic cancer	4.50	0.56	36.24	0.158	4.29	0.97	18.90	0.055
Ovarian cancer	1.06	0.14	7.88	0.954	NA	NA	NA	NA
Lung cancer	NS	NS	NS	NS	NS	NS	NS	NS
Transitional cell carcinoma	NS	NS	NS	NS	1.77	0.54	5.84	0.346
Renal cell carcinoma	NS	NS	NS	NS	1.58	0.21	12.03	0.657
Multiple myeloma	14.70	1.67	129.24	0.015*	NS	NS	NS	NS
Endometrial cancer	2.44	0.32	18.52	0.389	NA	NA	NA	NA
Age	1.04	1.02	1.06	0.000*	1.03	1.02	1.04	0.000*

OR, odds ratio; LL, lower limit; UL, upper limit; NA, not applicable; NS, data not sufficient.

The [*] means that these values are statistically significant.

A total of 8602 did not have MP, of them 720 (8.37%) had malignancy. The logistic regression analysis presented in Table 4 reveals significant insights into the predictors of MP. A significant association was observed between cancer and the presence of MP, cancer (vs no cancer) was associated with higher odds of MP (OR = 1.67; 95% CI 1.11–2.51; p = 0.013), highlighting a potential link between MP and malignancies. Age also emerged as a significant predictor, with an odds ratio of 1.031 (95% CI: 1.021–1.040, P < 0.001), suggesting that the likelihood of MP increases with advancing age. However, sex (male versus female) did not show a statistically significant association with MP (odds ratio: 1.320, 95% CI: 0.948–1.840, P = 0.101), indicating no strong gender-based predisposition in this analysis. These findings align with the previously observed associations within MP-positive cases, such as the increased prevalence of lymphoma in males (odds ratio: 3.6, P = 0.016) and the significant association of breast cancer with females (odds ratio: 3.04, P < 0.05). Collectively, these results underscore the multifaceted relationship between MP and malignancies, age, and other demographic factors, warranting further investigation into these links.

Table 4.

Logistic regression analysis for the prediction of presence or absence of MP.

		95% CI
Predictor	Odds ratio	Lower	Upper	p-value
Cancer:
No Cancer – Cancer	0.59822	0.39902	0.89688	0.013
Age	1.03052	1.02087	1.04026	<0.001
Sex:
Male – Female	1.32021	0.94751	1.83953	0.101

3.2. Imaging features

CT scans showed hyper attenuation of the mesenteric fat relative to the root of the mesentery in all cases. A mass effect on adjacent bowel loops was observed in 81% of cases. Subcentimeter mesenteric lymph nodes were present in all cases. Pseudo-capsule was detected in 59% of cases. A halo or ring sign was detected in 88% of cases (Table 5).

Table 5.

Computed tomography signs prevalence of mesenteric panniculitis.

Signs	N (%)
Fat mass in the small intestinal mesentery with mass effect	120 (81%)
Hyper attenuation of fat tissue relative to retroperitoneal fat tissue	148 (100%)
Fat mass containing lymph nodes and blood vessels	148 (100%)
Halo signs in lymph nodes or blood vessels	131 (89%)
Pseudocapsule	88 (59%)

PET-CT scans were performed in 12 of 39 patients with malignancy during the study period. None of the patients showed [18F]-2-fluoro-2-deoxy-D-glucose uptake (Figure 4). Seven of these 12 patients showed persistent mesenteric changes on follow-up PET-CT scans.

Figure 4.

Mesenteric fatty stranding and mesenteric lymph nodes with no [18F]-2-fluoro-2-deoxy-D-glucose uptake at the root of the mesentery.

4. Discussion

Mesenteric panniculitis (MP) is a chronic inflammatory condition of the small intestine mesentery, often detected incidentally on CT imaging. While its prevalence varies between 0.16% and 7.8%, pathophysiology and etiology remain incompletely understood [21]. MP can manifest as mesenteric fat degeneration, inflammation, or fibrous tissue formation, with malignancy frequently cited as a potential association. Historical studies reported malignancy in 30% of MP cases, particularly lymphoma. Subsequent research estimated malignancy prevalence in MP cases to range from 17% to 38%, though recent matched case-control studies challenge this association, suggesting MP may not be a paraneoplastic phenomenon [9]. Despite its unclear etiology, MP has been linked to various triggers, including surgery, autoimmune disorders, infections, and infarction. Middle-aged males, particularly around 60 years of age, are most commonly affected [22]. While most cases resolve spontaneously, symptomatic patients may require individualized treatment. Options include medications like steroids, tamoxifen, or colchicine, and in severe cases, surgery may be necessary for complications like bowel obstruction [1]. The link between MP and cancer remains controversial, with cancer prevalence among MP patients reported to range from 17% to 75% [12]. This variability and the shared age demographic complicate determining causality. Therefore, in this study, we aimed to clarify the relationship between MP and cancer by adjusting for confounders such as age, providing a more accurate assessment of this potential association.

4.1. Main findings of the study and alignment with previous studies

This study is among the most extensive collections of abdominal CT scans focusing on the identification of MP patients. The research investigates the prevalence, imaging features, and the connection between MP and various types of malignancies.

While previous study by Atacan et al. included a larger number of MP patients (n = 716), our study aimed at investigating the incidence of MP among all patients eligible, to study the association between malignancy and presence or absence of MP [23]. Numerous studies have examined the frequency of cancer among individuals with MP [5–7,9,14,24]. However, these findings were influenced by the overlapping age groups in which MP and cancer commonly manifest. Furthermore, certain studies retrospectively identified MP patients by searching through databases, potentially leading to an underestimation of the actual prevalence of MP.

Colorectal cancer, lymphoma, and urogenital tract malignancies are the most frequently observed malignancies linked to MP, aligning with our own research findings [25]. Among the patients in our cohort, 39 individuals (21.6%) had both MP and cancer. However, we were unable to determine the chronological sequence of MP and malignancy since we lacked access to abdominal CT scans conducted prior to the study period.

MP has been associated with certain risk factors, including abdominal surgery, autoimmune diseases, mesenteric ischemia, and diabetes [5,7,13]. Within our cohort, 34.9% of patients had undergone abdominal surgery for diverse reasons, while the prevalence of hypertension, diabetes, coronary artery disease, urolithiasis, and autoimmune diseases was determined to be 32.3%, 18.4%, 18.1%, 7.1%, and 1.9%, respectively. However, the clinical records did not provide information regarding the time interval between abdominal surgery and abdominal CT examinations.

The documented prevalence of cancer among MP patients has exhibited a wide range, ranging from 17.6% to 74.8% [5–7,9,14]. In our own cohort, 21.6% of MP patients were found to have malignancies. Nevertheless, the findings regarding the association between MP and cancer are inconsistent across various studies. For instance, Gögebakan et al., in their matched-pair analysis involving 77 MP cases, revealed no significant association between MP and cancer or other diseases [12]. Interestingly, the same research group, in a subsequent publication, reported an even lower prevalence of cancer in subjects with MP compared to the control group [26]. Conversely, van Putte-Katier et al., in their matched-pair analysis of 94 MP cases, demonstrated a significant association between MP and existing malignancies, as well as an increased risk of future cancer [24].

In the case-control study conducted by Khasminsky et al., it was found that the prevalence of MP among non-Hodgkin lymphoma (NHL) patients was 1.8%, which is not different to the prevalence in the general population [27]. Within our own cohort, a significant association between MP and lymphoma was observed in males, but not in females. Similarly, Khasminsky et al. noted that all NHL patients with MP in their study were males, indicating a gender-specific association. However, further investigation is necessary to better understand this association [27].

In our cohort, we found a robust association between MP and breast cancer in females, with an odds ratio (OR) of 3.04 (95% confidence interval [CI]: 1.46–6.34, p = 0.003). These findings suggest that genetic and hormonal factors may contribute to the development of MP. Additionally, we observed a significant association between MP and multiple myeloma among females.

Regarding the radiological features of MP, hyperattenuation of mesenteric fat and subcentimeter lymph nodes were present in all MP cases, and ring sign was seen in the majority of cases. Radiology exam has key features in identifying MP, with the majority being detected on CT scans. The characterization of MP typically shows a single heterogeneous mass predominantly localized in the mesentery. It is often left-sided and can cause displacement of the small intestine and surrounding structures due to mass effect as present in 81% of our cases. The mass effect of MP can potentially exert pressure on surrounding structures leading to clinical symptoms [28]. In a retrospective study by Gregory et al. investigated the CT-worrisome features in MP patients, showing two CT-based characteristics of MP had a significant association with newly diagnosed malignancy, and included the presence of at least one soft-tissue nodule within the MP region exceeding 10 mm in short-axis diameter and lymphadenopathy located in other areas of the abdomen or pelvis. In contrast, no significant association was observed with the absence of one or two of the five MP diagnostic signs or with the presence of splenomegaly. At the initial CT assessment, both significant features demonstrated the same level of sensitivity, as indicated in the confidence intervals [29].

In addition to the importance of radiology in aiding in the diagnosis of MP, it is very helpful in identifying potential complications of MP. This is typically feasible by identifying the spread and extent of MP, and if there is any occlusion, perforation, or intestinal ischemia which has been more commonly reported in patients with fibrotic infiltration in the peritoneal cavity which can also mimics peritoneal carcinomatosis [30,31]. Therefore, accurate radiological assessment of MP and its relationship with adjacent structures is essential for appropriate therapeutic planning. In cancer patients, PET/CT is essential to differentiate MP and MP with tumor involvement of the mesentery. In a study by Zissin et al. on 33 PET/CT scans to investigate the radiographic findings in cancer patients with MP showed that among MP patients, eight out of 19 showed focal [18F]-2-fluoro-2-deoxy-D-glucose (FDG) uptake, with 6 of them having non-Hodgkin lymphoma as the primary tumor, and the most commonly observed CT findings were hyper-attenuation, fat pseudo-capsule, and enlarged nodules. Their findings showed that CT findings were subtle in majority of patients even in the those with malignant mesenteric involvement, thus, distinguishing between benign and malignant causes could not be confidently achieved using CT alone. This emphasize on the important role of integrating PET/CT in the evaluation of MP detected on CT in cancer patients, as PET/CT can be particularly valuable in accurately ruling out mesenteric tumor involvement when no FDG uptake is observed in areas showing typical CT features of MP [13].

Given the aforementioned factors, there is currently limited scientific certainty regarding the precise association between MP and cancer, particularly due to the overlapping occurrence of MP and cancer within the same age group [32]. However, our study yielded distinct findings compared to the existing literature. Specifically, most of the cancers included in our study did not exhibit a statistically significant association with MP, except for breast cancer and multiple myeloma in females, as well as lymphoma in males. These outcomes suggest that MP may be influenced by both the type of tumor and the gender of the individual, rather than a generalized association with cancer as a whole.

4.2. Clinical implications of the study

The findings of the presented study have important clinical implications, particularly in the evaluation and management of MP in cancer patients. Although MP is often asymptomatic and detected incidentally on CT scans, its association with specific malignancies, such as lymphoma in males and breast cancer and multiple myeloma in females, underscores the need for clinicians to remain vigilant when MP is identified [28]. Age appears to be an independent risk factor for MP, further highlighting the importance of adjusting for age when investigating its association with malignancies [33]. Radiological evaluation remains fundamental for identifying MP and differentiating it from other mesenteric conditions, but CT alone may not confidently distinguish benign from malignant mesenteric involvement. Integrating PET/CT into the diagnostic workflow in cancer patients can play a critical role in ruling out mesenteric tumor involvement especially when no FDG uptake is observed [7]. These findings reinforce the importance of a multidisciplinary approach, combining radiological expertise with clinical correlation, to optimize therapeutic planning and long-term patient outcomes. Future studies with larger cohorts and prospective designs are needed to further clarify the relationship between MP, cancer subtypes, and patient demographics, enabling more precise risk stratification and management strategies.

This study is subject to certain limitations. Firstly, the long-term follow-up did not include an assessment of malignancy occurrence in the control group (patients without MP), in addition, the retrospective nature of the study limits the ability to control for confounding variables, which can affect the accuracy and reliability of the observed associations. Secondly, the identification of study patients relied on the database search using the term “mesenteric panniculitis,” which may have resulted in the potential omission of certain cases. Thirdly, the sample size was not sufficient to establish potential associations within specific categories of malignancies. Lastly, the exclusion of patients with liver cirrhosis, considering its impact on mesenteric morphology and the presence of ascites, prevented the evaluation of the relationship between MP and hepatocellular carcinoma.

5. Conclusions

In conclusion, it appears that cancer does not serve as a universal risk factor for MP. Instead, the association between MP and cancer is contingent upon the specific type of tumor and the sex of the patient. Moreover, age has been identified as an independent risk factor for MP. Upon adjusting for age as a confounding variable, our findings indicate that MP exhibits a distinct association with lymphoma in males, as well as with multiple myeloma and breast cancer in females.

Ethics approval

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki. The institutional review board of our center approved the study protocol (Approval No. 101–2018) and waived the need for informed consent.

Authors’ contributions

Naser Obeidat: Contributed to conceptualization, investigation, methodology, project administration, validation, visualization, and writing – both the original draft and the review & editing.

Mamoon Al-Omari, Jehad Fataftah, and Khaleel AlQararha: Contributed to data curation, formal analysis, investigation, methodology, resources, software, supervision, validation, and writing – both the review & editing.

Mohammed Al-Qaralleh: Contributed to conceptualization, methodology, project administration, validation, visualization, and writing – both the original draft and the review & editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.