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Case Reports
. 2022 May 13;14(5):e24971.
doi: 10.7759/cureus.24971. eCollection 2022 May.

Nodular Histiocytic/Mesothelial Hyperplasia Mimicking Mesenteric Metastasis

Joseph Grech  1 , Cullen M Lilley  1 , Emily M Martinbianco  1 , Xianzhong Ding  2 , Kamran M Mirza  2 , Xiuxu Chen  2
Affiliations
Case Reports

Nodular Histiocytic/Mesothelial Hyperplasia Mimicking Mesenteric Metastasis

Joseph Grech et al. Cureus. .

Abstract

Nodular histiocytic/mesothelial hyperplasia (NHMH) is a rare histologic entity, characterized by localized benign reactive proliferation of histiocytes and mesothelial cells. The presence of this rare entity poses a challenge in differential diagnosis, both in radiological findings and pathological interpretations under certain circumstances, and consequently has been misdiagnosed as malignancy. Here, we report a case of mesenteric NHMH in a patient with colonic mucinous adenocarcinoma. Histology shows numerous large calretinin (+) mesothelial cells mixed with CD68 (+) histiocytes by immunohistochemistry. In contrast to almost all previously reported cases with typical features of histiocytic predominance, the current case of NHMH mainly consists of mesothelial cells with intermixed histiocytes. The findings expand the histologic spectrum of NHMH and contribute to awareness of this entity in the differential diagnosis.

Keywords: histiocytosis with raisinoid nuclei (hrn); histioeosinophilic granuloma (heg); intralymphatic histiocytosis (ilh); mesothelial/monocytic incidental cardiac excrescences (mice); nodular histiocytic/mesothelial hyperplasia (nhmh); reactive eosinophilic pleuritis (rep).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cecal mass on endoscopy and microscopy
Endoscopy shows a 5.0 cm circumferential and partially obstructing mass in the cecum (A). Microscopic examination confirmed the diagnosis of stage pT3N0Mx mucinous adenocarcinoma (B, 200x).
Figure 2
Figure 2. Morphologic features of mesenteric nodular histiocytic mesothelial hyperplasia (NHMH) on representative section
The mesenteric nodular lesions show predominantly histiocytes (inset: arrows) and mesothelial cells (inset: arrowheads) as well as lymphocytes within the delicate fibrous septa by H&E stains (A). Immunostains confirm the presence of mesothelial cells with positive calretinin (B) and D2-40 (C), as well as histiocytes with strongly positive CD68 (D). Note: A 100x, B-D 600x
See this image and copyright information in PMC

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