Fact-sheet: Gastric carcinoma - Adenocarcinoma
Updated on 10/07/2017 at 6:31 AM
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Definition
Gastric linitis (or linitis plastica) is a diffuse form of adenocarcinoma, characterized by cellular proliferation in disorganized clusters diffusely infiltrating the gastric wall. The diagnosis of linitis is macroscopic, with a rigid, board-like, whitish wall taking on the appearance of linen. The gastric wall appears thickened and retracted, giving the stomach a fixed, narrowed appearance. The neoplastic infiltration thickens all layers of the wall without destroying them but spares the mucosa. Gastric linitis is the fourth histologic type of gastric adenocarcinoma described in the WHO pathological classification, almost always featuring signet ring cells within a fibrous stroma. Linitis can sometimes be localized.
Clinical features
Weight loss/general deterioration.
Laboratory findings
Serum tumor markers are not useful for diagnostic purposes. Carcinoembryonic antigen (CEA) and CA 19-9 are elevated in 40% and 30% of patients with metastatic cancer, respectively. However, they may be useful in follow-up after curative treatment or in assessing chemotherapy response.
CT
Gastric linitis: circumferential gastric wall thickening greater than 2 cm, with loss of the normal rugal folds and a rigid appearance.
Progressive contrast enhancement increasing on delayed phase (fibrous component).
Management
The prognosis of gastric linitis is generally poor (compared with lymphoma and well-differentiated adenocarcinoma); it depends on the degree of wall infiltration, peritoneal spread, and whether treatment is curative or palliative. The 5-year survival rate of operated patients is 7.5 to 22%.
Differential diagnosis
Gastric lymphoma.