Linitis plastica

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.

Pathology

The underlying cause is usually a scirrhous adenocarcinoma with diffuse submucosal infiltration, leading to thickening and rigidity to the stomach wall ². The histopathology subtype is a signet ring cell adenocarcinoma, characterized by abundant intracellular cytoplasm with displacement of the nucleus to the periphery of the cell.

It is important to realize that as the infiltration is submucosal, gastric biopsies are frequently negative ².

Radiographic features

Fluoroscopy

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.

CT

Typically the stomach is diffusely thickened with a small lumen. Evidence of nodal involvement or widespread metastatic disease should also be sought.

Differential diagnosis

Whether linitis plastica should be defined as only the appearance of the stomach, irrespective of cause, or used only in the setting of infiltrating adenocarcinoma of the stomach, is a source of disagreement. Thus, the causes of linitis plastica are also the differential, and include ^4,5:

• neoplastic
  • gastric adenocarcinoma (scirrhous)
  • metastases
    • breast
    • lung
• lymphoma: less rigid
• diffuse gastric diverticula (rare) ⁶
• inflammatory
  • radiotherapy
  • eosinophilic enteritis
  • granulomatous disease
    • Crohn disease
    • tuberculosis
    • sarcoidosis
• scarring (e.g. ingestion of corrosives)
• gastric amyloidosis

History and etymology

Linitis means inflammatory change, while 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.