One of the very first words I heard at diagnosis was the word “Mesentery“. In the news today is the announcement that is now might just be a new organ following accepted findings from research conducted in the University of Limerick Ireland. I always knew it was something which held the small and large intestines in place within the abdomen so like many others, I just thought it was some kind of membrane type structure and I also knew there was some kind of interaction with the peritoneum, another word which I was to become familiar with.
This is an important area for NET patients as many will have mesenteric involvement in their disease. I’ve read reports of a primary mesenteric tumour although it’s mainly a site for secondary disease (metastasis). It’s no surprise when you consider the geography – the small and large intestines are inextricably linked to this new organ. There is pancreatic involvement too. The mesentery contains many lymph nodes (the main place for metastasis for small intestinal NETs and other types) and has important blood vessels adding complexity to surgery. It’s also a place where there’s likely to be fibrotic reactions (desmoplasia) from the excess release of serotonin which can also complicate surgery.
When I check my own records, I can see statements such as “mesenteric disease”, “bulky mesenteric nodes”, “further nodal disease situated on the superior mesenteric artery and vein” and “dense retroperitoneal reaction encircling his aorta and cava from just below the level of the superior mesenteric artery”. When I also look at the post surgical reports, I can see that I had something called a “mesenteric root dissection” which needed a “superior mesenteric vein reconstruction”.
So there you have it, the anatomic description that had been laid down over 100 years of anatomy was incorrect. This organ is far from fragmented and complex. It is simply one continuous structure. According to the article I read, medical students started being taught that the mesentery is a distinct organ and the world’s best-known series of medical textbooks, Gray’s Anatomy, has even been updated to include the new definition. Finally, so what you might be thinking? Here’s a quote from the person who led the work:
“The next step is the function,” Coffey explained. “If you understand the function you can identify abnormal function, and then you have disease. Put them all together and you have the field of mesenteric science … the basis for a whole new area of science.”
Reference material:
http://www.sciencealert.com/it-s-official-a-brand-new-human-organ-has-been-classified
http://www.chicagotribune.com/lifestyles/health/ct-mesentery-new-human-organ-20170104-story.html
https://www.ul.ie/research/blog/irish-surgeon-identifies-emerging-area-medical-science
Thanks for listening
Ronny
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I would suggest an octreoscan. It has a somatostatin analog that attaches to all carcinoid tumors and shows them on a scan. If your child has a mesentery mass the octreoscan should show it. It is a relatively sophisticated scan and shows carcinoid NET only tumors well. If it isn’t a carcinoid it won’t “light” up on the scan. But it could be a different type of tumor if the octreoscan doesn’t confirm carcinoid. Hope you catch it early. Have a nice day.
thanks Bryan – confused by this comment? Who is it directed at please?
This interested me when I read about the mesentery being identified as it’s own organ. I’m curious as to what your thoughts might be on this. Our son has had multiple elevated CgA tests (roughly double the upper limit of normal) and one elevated plasma serotonin (that came down three months later). He’s only had CT and MRI for scans, but the MRI showed “mesenteric adenitis”. No one seemed overly concerned about it, including the NET specialist who viewed his MRI images, but I still can’t shake the worry. It it easy to distinguish between a simple swollen lymph node in this area vs. some kind of NET growth?
The abdomen is a tricky place with so many conflicting symptoms. I can understand why you might be spooked with the elevated CgA – there are other reasons why it might be elevated. CgA measures tumour bulk and I cannot see one lymph node would cause such an increase. That said, double the norm is not really high when I see the results from diagnosed NET patient – I have no idea how this works with kids. In these situations, I always say to people, if you are still concerned after consulting with physicians, seek a second opinion. I hope you get some answers or some piece of mind.