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Primary linitis plastica carcinoma of the colon and rectum.

BACKGROUND: Linitis plastica carcinoma (LPC) usually shows a scirrhous growth pattern with a severe stromal desmoplastic reaction. Another growth pattern showing lymphangiosis carcinomatosa rather than scirrhous growth pattern, however, was noted. This study was designed to clarify the clinical and pathologic characteristics of colorectal LPC. METHODS: Linitis plastica carcinoma was reviewed clinicopathologically and classified into two types according to the histologic growth pattern: The first was a scirrhous type (nine patients) and the second, a lymphangiosis type (three patients). RESULTS: Grossly, the mucosal surface of the scirrhous type had a granular, cobblestone, gyriform-like appearance. The cancer cells were composed mainly of poorly differentiated or signet-ring cells and were accompanied by a severe stromal desmoplastic reaction; lymphatic permeation was not so marked. Most patients with this type of cancer died of peritonitis carcinomatosa. The mucosal surface of the lymphangiosis carcinomatosa had a smooth and glossy appearance. The cancer cells were composed mainly of moderately differentiated cells, frequently with a glandular formation. Stromal desmoplastic reaction was not so marked. The growth pattern was characterized by lymphangiosis carcinomatosa and marked venous invasion. All patients who had this type died of distant metastases. CONCLUSION: Perhaps with earlier diagnosis and aggressive treatment, the peritoneal dissemination of scirrhous LPC and distant metastasis of lymphangiosis LPC may be minimized.

Adenocarcinoma, Scirrhous↗

Primary linitis plastica carcinoma of the colon and rectum.

Primary linitis plastica of the colon or rectum is a rare entity. Only 85 cases of this type cancer have been reported in the English medical literature. We report two cases, including the oldest known patient presenting uniquely with a sigmoid volvulus and another patient presenting with fecal incontinence and perianal pain. Linitis plastica of the colon or rectum is characterized by presentation in younger patients and is associated with metastatic disease, a high mortality, and insidious growth, often making detection difficult. A high degree of suspicion must therefore be held; a low threshold for endoscopic and echoendoscopic diagnostic intervention also should be maintained. Endoscopic ultrasound provides a unique view of its circumferential infiltrating pattern for diagnosis and staging, but further experience is necessary to establish whether the early use of endoscopic ultrasound favorably impacts mortality.

Aged↗

Primary linitis plastica of the small bowel. Case report.

Linitis plastica carcinoma of the gastrointestinal tract is rare. No case with origin in the small intestine has been reported in the available literature. A 29-year-old man with vague abdominal symptoms and bilateral inguinal lymphadenopathy was found to have primary linitis plastica of the ileum. The prognosis is poor.

Adult↗

An African patient with AIDS and linitis plastica.

This is a case report about an African patient with AIDS who was diagnosed with a linitis plastica of the stomach. The evolution of this linitis plastica does not differ in any aspect from that in HIV-negative patients. The question remains unanswered whether there is a link between the HIV infection and the development of linitis plastica in this patient.

Acquired Immunodeficiency Syndrome↗

Primary linitis plastica carcinoma of the colon: a case report.

Primary linitis plastica carcinoma of the colon is rare. Most lesions are located on the left side of the colon and these tumors often involve the lymph nodes, peritoneum, and ovaries. We report a case of primary linitis plastica of the sigmoid colon in a 32-year-old Chinese woman who presented with a 7-month history of constipation and associated abdominal pain and tenesmus. Colonoscopy and barium-enema studies showed a stricture at the sigmoid colon. The patient underwent radical surgical resection and received adjuvant radiation therapy and chemotherapy. She died 12 months after the initial diagnosis. The poor prognosis seen with this tumor is due largely to a delay in diagnosis. With increasing familiarity with this tumor, it is hoped that earlier diagnosis and curative surgery will be possible, leading to improvement in survival.

Adult↗

Metastatic breast cancer presenting as linitis plastica of the stomach.

Early detection and treatment of breast cancer, leading to longer survival, has revealed the natural history of this disease process. Linitis plastica of the stomach is a potential long-term sequela of metastatic breast cancer. Here we present a case of metastatic breast cancer presenting as linitis plastica, as well as the treatment algorithm for this rare clinical entity. The world literature describes a clear pattern of linitis plastica for metastatic infiltrating lobular breast cancer and a discrete nodular pattern for infiltrating ductal cancer, in regard to metastasis to the stomach. To our knowledge, this is the first case of infiltrating ductal cancer presenting as linitis plastica of the stomach.

Breast Neoplasms↗

Primary linitis plastica of the rectum: report of four cases and review of the literature.

Primary linitis plastica of the rectum is a rare form of large bowel carcinoma, with only 30 cases having been reported in the English literature to date. Of significance is the fact that it carries a prognosis that is poor compared to other types of colorectal cancers. We report herein the cases of four patients with primary linitis plastica of the rectum who underwent surgery, followed by intensive postoperative chemotherapy using 5-fluorouracil (5-FU) derivatives in our institution. A review of the literature is presented with special reference to the diverse treatment and prognosis of this unusual disease. Although three of the patients died of recurrent cancer, one has survived for 5 years and 10 months despite advanced disease. This is only the third reported case of a patient with linitis plastica of the rectum achieving 5-year survival. We believe that this unexpected long survival could be related to the patient's extensive lymphadenectomy and intensive postoperative chemotherapy using cisplatin and 5-FU derivatives.

Aged↗

Metastatic carcinoma simulating linitis plastica of the colon. A case report.

Reported herein is the case of a 70-year old woman with metastatic breast carcinoma presenting as linitis plastica of the ascending colon. The breast tumor was diagnosed nine years previously. The clinical, roentgenographic and pathologic features of colonic linitis plastica and the preoperative diagnostic difficulties are discussed. There is no difference in the morphologic features of primary and secondary linitis plastica. The latter may result from anaplastic carcinoma of the stomach, gallbladder or breast.

Adenocarcinoma, Scirrhous↗

Perianal extramammary Paget's disease associated with primary linitis plastica of the rectum: report of a case.

We report herein a case of perianal extramammary Paget's disease associated with primary linitis plastica of the rectum. An 82-year-old woman was admitted to our hospital for investigation and treatment of a perianal eczematous lesion. A skin biopsy of the lesion revealed perianal extramammary Paget's disease and a barium enema demonstrated diffuse narrowing with an irregular contour at the ampulla recti. Under a suspected diagnosis of linitis plastica of the rectum, an abdominoperineal resection was performed to resect both the rectal and perianal lesions with regional lymphadenectomy. Grossly, marked narrowing and wall thickness were observed at the lower rectum, and a histological diagnosis of signet ring cell carcinoma was confirmed. The perianal eczematous lesion revealed many atypical cells with clear cytoplasm, being Paget cells, throughout the entire epidermis. Sparse distributions of signet ring cells were also observed in the subcutaneous tissue beneath the perianal eczematous lesion. The pathogenesis of perianal extramammary Paget's disease in this patient was therefore considered to be an intraepidermal extension of primary linitis plastica of the rectum.

Aged↗

[Primary colonic linitis plastica. Apropos of 3 new cases].

Primary linitis plastica of the colon is unfrequent. Since Laufmann and Saphir's first cases in 1951, less than 50 cases have been described, to which our three new cases now add. The intramural origin with late involvement of the mucosa delays the onset of clinical signs, and accounts for the rarity of overt bleeding and for the frequent failure of biopsy. The radiological appearance is that a tubular colic narrowing without ulceration or intraluminal process. Endoscopy shows regular, centered stenosis with few modifications of the mucosa. The clinicopathological diagnosis is primarily microscopic: presence of isolate mucosecretory neoplastic cells infiltrating the whole wall of the colon without destroying it. Because of its potential for local invasion and of its centripetal extension, linits is often detected only at the equivalent of stage C (Astler-Coller). The prognosis is poor, with survival averaging 1 year after the onset of the first clinical signs.

Adult↗

Primary colo-rectal linitis plastica type of carcinoma: report of two cases and review of the literature.

Linitis Plastica type of carcinoma can arise primarily in the colon or rectum. Fifty-two cases have been reported in the English medical literature over a 50-yr period. Two new cases are described. One patient had primary linitis plastica of the ascending colon, the other being in the rectum. Both patients died of widespread malignancy within 10 mth of diagnosis, the fate of most of the reported cases. This rare manifestation of colo-rectal carcinoma carries an ominous prognosis.

Adenocarcinoma, Scirrhous↗

CT features of metastatic linitis plastica to the rectum in patients with peritoneal carcinomatosis.

OBJECTIVE: We examined the CT features of 22 patients with metastatic linitis plastica to the rectum. CONCLUSION: Metastatic linitis plastica to the rectum should be considered when CT shows a long segment of circumferential rectal wall thickening, especially in patients with peritoneal carcinomatosis from gastric cancer. In such patients, CT helps avoid unnecessary extensive surgery.

Adult↗

Primary linitis plastica of the descending colon: a case report.

A rare case of primary linitis plastica carcinoma of the colon seen in a 44 year old Japanese man is described herein. The patient had a complete obstruction of the descending colon and was treated with a loop colostomy followed shortly afterward by a left hemicolectomy. At the time of the second operation, the entire thickness of the colonic wall was found to be infiltrated by cancer cells, however, the other intraabdominal organs were free of cancerous involvement. The histopathological diagnosis made at this time was primary linitis plastica carcinoma of the descending colon. Nine months later, the patient developed an intestinal obstruction and relaparotomy revealed diffuse peritoneal dissemination. Two years after the first operation, upper GI films and a gastrofiberscopic examination revealed gastric involvement. The patient died 28 months after his initial operation, and autopsy revealed widespread metastases in the peritoneal surface, paraaortic lymph nodes, small intestine, remaining colon and stomach.

Adenocarcinoma, Scirrhous↗

Clinicopathological and histochemical studies of linitis plastica type gastric cancer with special reference to early gastric cancer in the region of the fundic gland.

In this study, early gastric cancer in the region of the fundic gland was found to occur predominantly in women. Many lesions of this type were identified in the posterior wall of the middle portion of the stomach. Histologically, the lesions were classified as poorly differentiated carcinomas in all cases of early cancer. On the other hand, in 9 patients with cancer of linitis plastica type having IIc lesions (less than 2.0 cm in diameter) located in the region of the fundic gland, the tumor focus was also in the posterior wall of the middle portion of the stomach. Giant folds were present diffusely in all other portions of the gastric mucosa in these latter cases. These cases also had diffuse infiltration of cancer cells into the submucosa, muscle layer and extraserosal regions. Histologically, the lesions were classified, in all cases of linitis plastica type, as poorly differentiated carcinomas including signet ring cells. Acid mucopolysaccharides (AMPS) and sialic acid were histochemically detected in the interstitial tissues of early gastric carcinomas and linitis plastica type gastric cancers. The AMPS digestion rates were higher for early cancer tissue. The present results support the hypothesis that early gastric cancer in the region of the fundic gland may occur in conditions favorable to tumor growth and may develop into cancer of linitis plastica type.

Adult↗

[Case report of isolated Crohn's disease of the stomach presenting as plastica linitis].

INTRODUCTION: Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis. Exégèse: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease. CONCLUSION: Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach.

Aged↗

[Rectal linitis plastica with urologic presentation. Apropos of 3 cases].

The authors report three cases of rectal linitis plastica which presented in a novel manner by urological manifestations. The diagnosis of these lesions was based essentially upon deep rectal, bladder and prostate biopsies as well as CT scan. These three clinical cases illustrate the dreadful prognosis of rectal linitis plastica, agreeing with conclusions emerging from a review of the literature.

Adenocarcinoma↗

Linitis plastica caused by metastatic lobular carcinoma of the breast.

We describe herein the syndrome of linitis plastica caused by metastatic lobular carcinoma of the breast. In 14 of our 31 patients, gastric involvement, alone or concurrent with other metastasis, provided the first sign of tumor dissemination. The distinction of primary and secondary gastric malignancies in patients with a history of breast cancer is most important for successful management of patients. At a time when primary gastric carcinoma is decreasing nationally, an awareness of the association of lobular breast tumors with linitis plastica due to metastases may modify diagnostic evaluation and treatment planning in patients who present with symptoms of this syndrome.

Adenocarcinoma, Scirrhous↗