Linitis Plastica Commonly Metastasizes with Poor Prognosis
Linitis plastica is a highly aggressive form of gastric cancer that typically presents with extensive metastatic disease at diagnosis, resulting in poor survival outcomes. 1
Pathological Features and Metastatic Pattern
Linitis plastica is characterized by:
- Diffuse infiltration of the stomach wall with signet-ring cell morphology 1
- Classification as Borrmann Type IV in advanced gastric cancer 1
- Poorly differentiated cells with discohesive pattern infiltrating the gastric wall 2
- Extensive desmoplastic (fibrotic) response in the gastric tissue 3
Metastatic Behavior
Linitis plastica demonstrates aggressive metastatic behavior:
- Early lymph node metastasis is common, even in relatively small tumors 3
- Peritoneal spread is frequently observed, often before diagnosis 4
- Distant metastasis to liver, lungs, and bone may occur 2
- Can metastasize to unusual sites including the rectum 5
Diagnostic Challenges and Metastatic Detection
The diagnosis of linitis plastica is often delayed due to:
- Lack of early symptoms until advanced disease stage 4
- Submucosal infiltration making standard biopsies challenging 1
- Diffuse nature of the disease requiring specialized imaging techniques 3
For accurate staging and detection of metastases:
- Comprehensive CT, EUS, and laparoscopy with peritoneal washings are essential 1
- Delayed-phase multislice CT can detect fibrotic lesions and evaluate tumor invasion extent 3
- Deep biopsies are necessary as superficial biopsies may miss the malignancy 5
Prognosis and Treatment Implications
The metastatic nature of linitis plastica significantly impacts prognosis:
- In a clinical series of 8 patients, only one was eligible for potentially curative surgery 4
- Most patients are offered palliative or supportive treatment due to advanced disease 4
- Metastatic disease can present with rapid acute deterioration 6
- Secondary linitis plastica can occur from metastasis of other primary cancers (breast, prostate) 7, 5
Clinical Pearls and Pitfalls
- Key pitfall: Relying on standard endoscopic biopsies alone may lead to false negatives due to the submucosal nature of the disease
- Important consideration: Distinguishing between primary linitis plastica and metastatic disease from other sites (particularly lobular breast carcinoma) is crucial for management 7
- Warning sign: Rapid deterioration in a patient with gastrointestinal symptoms may indicate widespread metastatic disease from linitis plastica 6
The high metastatic potential of linitis plastica underscores the importance of early, comprehensive staging and the recognition that curative treatment options are limited for most patients at diagnosis.