Linitis plastica

Last revised by Mostafa Elfeky on 19 Feb 2024

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 of 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 cell's periphery.

It is important to realize 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 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 differential, and include 4,5:

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.

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