Case History: 62-year-old male presents with history of abdominal pain and weight loss for two months.
Laboratory tests revealed hemoglobin of 13.7 g/dl with normal renal and liver function tests.
Figure 1. CT: Diffuse thickening of the gastric wall with few regional lymph nodes.
Figure 2. CT: An indeterminate right adrenal lesion.
Figure 3. MRI: Dual echo images showing drop of signal in opposed phase in MRI representing intracellular fat consistent with benign adenoma (arrows).
Figure 4. Linitis plastica of the stomach, which typically has a signet ring cell pattern of adenocarcinoma diffusely infiltrating the stomach.
Endoscopic ultrasound revealed the involvement of all three layers of the gastric body with breached muscularis propria.
CT also demonstrated an indeterminate right adrenal nodule showing progressive enhancement in the arterial and venous phase.
Metastatic disease was excluded and the patient underwent an uneventful total gastrectomy followed by adjuvant chemotherapy.
Linitis plastica accounts for 3%-19% of gastric cancers.
The term “linitis plastica” was coined by Brinton in 1859.
Signet ring cell adenocarcinoma of the stomach is characterized by diffuse infiltration of signet ring type of tumor cells into the gastric wall.
The main carcinogenic event in diffuse type cancers is loss of expression of E-cadherin, a key cell surface protein for establishing intercellular connections.
Hereditary diffuse gastric cancer are autosomal dominant, have very high penetrance with a lifetime cumulative risk of 40%-67% in men and 60%-83% in women.
The preoperative work-up involves an assessment of the spread of the disease.
Chest X-ray can be used to assess for metastases, though CT is preferred, especially for proximal cancers.
The treatment of linitis plastica is indefinite as authors are divided with regards to treatment plans.
