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Gastric metastases from breast cancer (linitis plastica)

Case contributed by Michael P Hartung
Diagnosis almost certain

Presentation

Abdominal discomfort. History of breast cancer.

Patient Data

Age: 70 years
Gender: Female

Large left effusion with pleural nodules. 

Soft tissue thickening and enhancement of the gastric fundus. Enhancing peritoneal and retroperitoneal implants. Heterogeneously enhancing uterus due to tumor infiltration and enlargement/infiltration of the adnexae. Implant in the posterior bladder wall. 

Malignant obstruction of the distal left ureter with a rounded soft tissue mass resulting in moderate upstream dilation. Narrowing of the distal right ureter with mild upstream dilation. 

Growth of infiltrative tumor in the stomach. Growth of peritoneal, retroperitoneal, and pelvic disease. New bilateral percutaneous nephrostomy tubes. Left effusion is smaller. 

Case Discussion

Rapid growth of enhancing, infiltrative tumor within the stomach over 3 months from breast cancer metastases, which is also referred to as linitis plastica. This case has an unusual appearance on the spectrum of carcinomatosis as it is largely characterized by enhancing, infiltrative tumor in a variety of locations, but with the stomach is a site of particularly extensive disease. This case is a helpful reminder that although a primary gastric tumor is more likely to cause this appearance, both breast and lung cancers can also result in infiltrative gastric metastases. 

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