Gastric adenocarcinoma - linitis plastica (pathology)

Case contributed by Dr Andrew Ryan

Presentation

Presented with early saiety, loss of weight and abdominal pain.

Patient Data

Age: 70 years
Gender: Female

Stomach, opened longitudinally along the lesser curve. There is marked thickening of the gastric wall with mucsoal congestion and decrease in rugal folds. There was no localized mucosal lesion and no evidence of erosion or ulceration. 

Histo (low power) - Thick, eosinophilic smooth muscle bundles of the muscularis propria. There is an increase in cellularity within the muscle wall. 

Histo (high power) - There are single and small clusters of relatively small uniform cells percolating between the bundles of smooth muscle cells. These are the tumor cells of diffuse type gastric adenocarcinoma (Lauren classification); unlike their 'intestinal' counterpart, there is minimal glands formation. In many cases these cells still produce mucin and may contain intracytoplasmic mucin vacuoles (true 'signet ring' carcinoma). 

Cytokeratin immunohistochemistry on regional lymph node - this is the result of a cytokeratin (epithelial marker) immuno with metastatic tumor cells showing positive staining (brown) while the adjacent lymph node tissue, including a rounded lymphoid follicle, shows pale blue counterstaining only.

Histo (fourth image) - This demonstrates adjacent normal gastric mucosa (see below for study question).

Case Discussion

This is a case of diffuse gastric adenocarcinoma (Lauren classification) presenting surgically as 'linitis plastica' (leather bottle stomach). Microscopic regional lymph node metastases were present.

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Case information

rID: 16159
Published: 24th Dec 2011
Last edited: 13th Aug 2019
Inclusion in quiz mode: Excluded

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