Linitis plastica

Battifora H. Metastatic breast carcinoma to the stomach simulating linitis plastica. Appl Immunohistochem. 1994 2 225-228. 

Linitis plastica thickened "leather bottle -like stomach... 

Fig. 2.14a-c. Linitis Plastica of the stomach. Double Contrast barium study (a) shows a marked circumferential narrowing of the fundus and proximal body of the stomach. Ultrasound (b) and CT (c) confirm extensive thickening of the gastric wall. Multiple biopsies confirmed the presence of linitis plastica... 

Fig. 4.5. Linitis plastica. This patient had a normal but difficult endoscopy in which distension of the stomach was problematical. He had symptoms of dyspepsia, early satiety, and weight loss, and the barium study clearly shows a linitis pattern in the fundus...

Fig. 4.19a,b. Linitis plastica. In this patient with pernicious anaemia and gastric atrophy, an infiltrating, scirrhous carcinoma had developed which was not appreciated at endoscopy. The examinations (a) and (b) were separated by two years. Note the nodular, nondistensihle stomach in (b)... 

Fig. 4.20a,b. Linitis plastica. Another example of a scirrhous carcinoma with linitis plastica appearance undiagnosed by endoscopy. Poor distensibility ofthe stomach is shown on the harium study (a) and wall thickening confirmed by CT (b)... 

Fig.4.23. Eosinophilic gastroenteritis. Linitis plastica appearance caused by eosinophilic gastroenteritis. The clue to the diagnosis relates to the infiltration extending into the duodenum, although this was not appreciated at endoscopy...

Primary tuberculosis of stomach and duodenum is very rare and usually develops secondary to pulmonary tuberculosis. Simultaneous involvement of the duodenum occurs in 10% of patients. There is increased incidence in patients with AIDS. The radiological appearances are classified as predominantly ulcerative or hypertrophic type (Tishler 1979 Agrawal et al. 1999). The ulcerative form is more frequent and consists of multiple large and deep ulcerations, sometimes with antral fistulas (Fig. 5.10). In the hypertrophic form, there is thickening of stomach and duodenal folds which can lead to pyloric stenosis and gastric outlet obstruction. A narrowed antrum can mimic a linitis plastica appearance. There is usually extensive lymph node involvement in the adjacent areas (Tishler 1979 Agrawal et al. 1999). Sarcoidosis and syphilis have identical appearances on conventional barium studies, both ulcerative and hypertrophic (Fig. 5.11). 

Fig. 5.22 Gastric carcinoma a Double-contrast barium meal shows an ulcerated, polypoid greater curve tumour, b Infiltrative gastric carcinoma producing a linitis plastica or leather bottle appearance ...

Gastric metastases are uncommon. They may appear as a solitary mass (50%), multiple nodules (30%), or diffuse infiltrative involvement of the stomach. The most common primary tumours that metastasize to the stomach are malignant melanoma, hreast, lung, colon, and secondary lymphomas. At douhle-con-trast harium meal, melanoma metastases appear as multiple umhilicated nodules - hull s-eye appearances. Kaposi s sarcoma can produce identical appearances (Dutta and Costa 1979). Metastases from invasive lobular breast carcinoma produce a linitis plastica-type appearance typically involving the antrum (Fig. 5.23c), whereas those from invasive ductal carcinoma tend to be nodular (Harare et al. 2001). Tumours of adjacent organs can produce an extrinsic mass effect on the stomach (Fig. 5.26). 

Fig. 6.1.12. A diffusely infiltrating carcinoma involving both walls of the stomach. This will eventually produce a linitis plastica appearance...

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