A 44-year-old previously healthy man from Mexico presented with 10 days of abdominal pain, nausea, and vomiting. The exam was remarkable for decreased left-sided breath sounds, diffuse abdominal tenderness, and mild abdominal distention. Chest radiograph showed a large left pleural effusion. Computed tomography of the abdomen demonstrated a markedly thickened stomach wall, loculated peritoneal fluid collections, paraaortic lymphadenopathy, and omental carcinomatosis (Fig. 1). Thoracentesis was performed and cytopathological examination of the pleural fluid showed a poorly differentiated adenocarcinoma of upper gastrointestinal origin. Esophagogastroduodenoscopy revealed a diffusely thickened and rigid stomach indicating extensive intramural malignant infiltration consistent with “linitis plastica” (Fig. 2); gastric biopsy confirmed diffuse-type gastric adenocarcinoma.
Originally coined by William Brinton in 1854, linitis plastica, also known as leather bottle stomach, accounts for 3–19 % of all gastric cancers, and portends a poor prognosis.1,2 A case series of 86 patients reported 1-year and 7-year survival rates of 50 % and 8 %, respectively, despite surgical resection.3 In this case, the inelasticity of the patient’s stomach resulted in intractable nausea and vomiting, for which a nasogastric tube was inserted for as-needed suctioning. Given the extent of his tumor burden, the patient was treated with symptomatic management and transitioned to home hospice.
REFERENCES
Wanebo HJ, et al. Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg. 1993;218(5):583–92.
Hamy A, et al. Study of survival and prognostic factors in patients undergoing resection for gastric linitis plastica: a review of 86 cases. Int Surg. 1999;84(4):337–43.
Armstrong GE. Linitis plastica. Can Med Assoc J. 1914;4(9):770–5.
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Parikh, R.V., Frost, N., Green, A. et al. A Leathery Lining. J GEN INTERN MED 29, 243 (2014). https://doi.org/10.1007/s11606-013-2518-x
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DOI: https://doi.org/10.1007/s11606-013-2518-x