Linitis plastica is a descriptive term usually referring to the appearance of the stomach, although the rectum can also be described this way. The appearance is said to be reminiscent of an old leather water-bottle.
The underlying cause is usually a scirrhous adenocarcinoma with diffuse submucosal infiltration, leading to thickening and rigidity to the stomach wall 2.
It is important to realise that as the infiltration is submucosal, gastric biopsies are frequently negative 2.
During a barium meal, the stomach cannot be adequately distended due to the increased rigidity of the wall with only a narrow lumen identified. The normal mucosal fold pattern is absent, either distorted, thickened, or nodular 2.
Typically the stomach is diffusely thickened with a small lumen. Evidence of nodal involvement or widespread metastatic disease should also be sought.
Whether you define linitis plastica as only the appearance of the stomach, irrespective of cause or use it only in the setting of infiltrating adenocarcinoma of the stomach is up to you, but be aware that there does not appear to be general agreement. Thus the cause of linitis plastica are also the differential, and include 4,5:
- gastric adenocarcinoma (scirrhous)
- lymphoma: less rigid
- diffuse gastric diverticula (rare) 6
- scarring (e.g. ingestion of corrosives)
- gastric amyloidosis
History and etymology
Etymology: linitis means inflammatory change, plastica means inelastic, not pliable.
The term was coined by William Brinton (1823-1867) in 1854. Hence the disease is also unsurprisingly called Brinton disease.
- 1. Levine MS, Pantongrag-brown L, Aguilera NS et-al. Non-Hodgkin lymphoma of the stomach: a cause of linitis plastica. Radiology. 1996;201 (2): 375-8. Radiology (abstract) - Pubmed citation
- 2. Curati WL. Imaging in Oncology. Cambridge Univ Pr. (1998) ISBN:1900151030. Read it at Google Books - Find it at Amazon
- 3. Rudralingam V, Dobson MJ, Pitt M et-al. MR imaging of linitis plastica of the rectum. AJR Am J Roentgenol. 2003;181 (2): 428-30. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Burgener FA, Kormano M, Pudas T. Differential diagnosis in conventional radiology. Thieme Publishing Group. (2008) ISBN:3136561031. Read it at Google Books - Find it at Amazon
- 5. Chapman S, Nakielny R. Aids to radiological differential diagnosis. Saunders Ltd. (2003) ISBN:0702026506. Read it at Google Books - Find it at Amazon
- 6. Patel SD, Semeraro D, Hall RI. Linitis plastica due to gastric diverticulosis. J R Soc Med. 2005;98 (9): 416-7. doi:10.1258/jrsm.98.9.416 - Free text at pubmed - Pubmed citation