From the Guidelines
Linitis plastica is a type of gastric cancer characterized by the diffuse infiltration of the stomach wall, resulting in a rigid, leather-like appearance.
Characteristics of Linitis Plastica
- It is a variant of diffuse gastric cancer, often associated with signet-ring cell carcinoma 1
- The stomach wall becomes thickened and rigid, resembling a leather bottle, due to the infiltration of cancer cells 1
- It can affect most of the stomach and is commonly seen in advanced carcinomas 1
- Histopathologically, it is characterized by the infiltration of atypical cells with diffuse growth, cords, microglands, and small mucin lakes 1
Classification and Diagnosis
- Linitis plastica is classified under the Lauren classification as a diffuse type of gastric cancer 1
- The WHO classification is also used in the pathological report to diagnose and classify gastric cancer, including linitis plastica 1
- Advanced HDGC (Hereditary Diffuse Gastric Cancer) also presents as linitis plastica, with similar histopathological features 1
From the Research
Definition and Characteristics of Linitis Plastica
- Linitis plastica is a carcinoma with a scirrhous stroma, involving the submucosal and muscular layers of the stomach, even in the absence of mucosal alteration 2.
- It is characterized by the infiltration of the gastric wall, thickening of the gastric folds, and a "leather bottle appearance" 3, 4.
- The primary cancer cells are often signet-ring cells or scattered cells in the context of a poorly differentiated carcinoma 2, 5.
Diagnosis and Challenges
- Diagnosis of linitis plastica is challenging due to its submucosal location and minimal mucosal alterations 2, 5.
- Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and probe-based Confocal Laser Endomicroscopy (pCLE) can contribute to the detection of malignant cells and abnormal vascular patterns 5, 6.
- The diagnostic sensitivity of endoscopy is poor due to the difficulty of biopsies, and endosonography is currently the reference examination for identifying localized linitis plastica 4.
Treatment and Prognosis
- Surgical resection is the only potentially curative approach for linitis plastica, and curative-intent surgery should be performed when feasible 2, 5, 4.
- The prognostic significance of linitis plastica is still controversial, and its severity is explained by the frequency of peritoneal dissemination, lymphatic invasion, and extension toward neighboring organs 2, 4.
- Modern chemotherapy protocols and multimodality treatment approaches may be promising for improving treatment outcomes 2, 4.