In this case, Esophagogastroduodenoscopy demonstrated diffuse gastric thickening and non-distensibility suspicious for diffuse infiltration consistent with linitis plastica.
Linitis plastica (LP) is a cause of diffuse FDG uptake with the thickened gastric wall. Primary gastric adenocarcinoma infiltrating the submucosa and muscularis is the most common cause of LP. Although metastatic involvement is an infrequent cause, infiltrating lobular carcinoma of the breast is reported to be the most common metastatic cause of LP [4].
Linitis plastica is not considered a separate entity in the staging or classification of gastric cancer; rather, it is taken as just a part of the diffuse infiltrating gastric cancer, but its influence on morbidity and mortality is well established[3]. Linitis plastica is mostly asymptomatic till advanced disease[2];
Question2. What are the causes of Linitis plastica:
• Atrophic gastritis (Dyspepsia and decreased distensibility along with malnutrition due to destruction of the mucosa and loss of mucosal folds)
• Hypertrophic H.pylori chronic gastritis ( hypertrophy in mucosal folds due to submucosal infiltration, but here distensibility will remain intact)
• Corrosive gastritis (it will be accompanied by corrosive esophagitis with identification from the history)
• Other types of diffuse infiltration as lymphoma, GIST, non-Hodgkins lymphoma, adenocarcinoma).
• Watermelon stomach with portal hypertension and loss of distensibility from the congestion.
• Post partial gastrectomy loss of gastric volume and distensibility (history of the previous operation is identified) [1].
References:
1. El-Nakeep S, Kasi A. Linitis Plastica. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563294/
2. Jafferbhoy S, Shiwani H, Rustum Q. Managing Gastric Linitis Plastica: Keep the scalpel sheathed. Sultan Qaboos Univ Med J. 2013 Aug;13(3):451-3.
3. Luu C, Thapa R, Woo K, Coppola D, Almhanna K, Pimiento JM, Chen DT, Marquez DD, Hodul PJ. Does histology really influence gastric cancer prognosis? J Gastrointest Oncol. 2017 Dec;8(6):1026-1036.
4.Yagi Y, Sasaki S, Yoshikawa A, Tsukioka Y, Fukushima W, Fujimura T, Hirosawa H, Izumi R, Saito K. Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: A case report. Oncol Lett. 2015 Dec;10(6):3483-3487. doi: 10.3892/ol.2015.3788. Epub 2015 Oct 9. PMID: 26788154; PMCID: PMC4665745.