Mesenteric panniculitis mimicking early recurrence at end-of-treatment evaluation in malignant lymphoma: Differentiation by active surveillance with F-18 FDG PET/CT imaging

Mesenteric panniculitis is a relatively rare fibro-inflammatory condition of the mesentery. In acute phase, it demonstrates avid uptake on Fluorine-18 FDG PET/CT (PET/CT). Thorough assessment is needed to differentiate from viable or recurrent disease in patients with malignant lymphoma because it mimics active lymphomatous disease on PET/CT. In this article, 3 illustrative cases of malignant lymphoma are presented. PET/CT demonstrated new FDG-avid mesenteric lesions at the end-of-treatment evaluation while the original disease showed significant response. Early recurrence was initially suspected, but together with clinical course and findings, active surveillance was opted. Sequential follow-up PET/CTs showed various patterns of metabolic activity over time; it can persist for months or more, or metabolic activity can fluctuate over time. Eventually benignity was confirmed in these cases. These cases underscore the importance of interpretation with clinical context and awareness of chronological metabolic changes of mesenteric panniculitis to determine proper management.