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PubMed1994

Efficacy of combined 5-fluorouracil and cisplatinum in advanced gastric carcinomas. A phase II trial with prognostic factor analysis.

Combined chemotherapy has demonstrated a degree of efficacy in gastric carcinoma. As 5-fluorouracil (5FU) and cisplatinum are two of the most active drugs, we have tested the efficacy of combined 5FU and cisplatinum in a prospective phase II trial. Cycles were administered every 4 weeks and consisted of 5FU 1000 mg/m2/day 5 days continuous intravenous (i.v.) infusion and cisplatinum 100 mg/m2 on day 2. Cycles were repeated according to tolerance and efficacy. 87 patients entered the study, 57 with metastatic or recurrent tumour (M) and 30 with locally advanced gastric cancer (LAGC). The response rate for the 83 evaluable patients was 43% [95% confidence interval (CI) 30-56%]. There were four complete responses (5%), 32 partial responses (39%), 34 cases of stable disease and 13 cases of progressive disease. Responses were more frequent in patients with a good performance status (P = 0.02), with their primary located in the cardia (P = 0.003), with a non-linitis plastica tumour form (P = 0.003) or a tumour containing less than 50% of independent cells (P = 0.016). Median survival was 9 months for the total population. It was better in patients with a good performance status (P = 0.01), and those who did not have linitis plastica (P = 0.005). Toxicity was acceptable, although grade 3-4 neutropenia was reported in 22% of the cycles, mucositis in 14% and 3 patients died of septic complications. The combination of 5FU and cisplatinum is effective in terms of tumour response in advanced gastric cancer and warrants testing with the other active regimens.

Adult↗
PubMed1990

[A case of Borrmann type 4 colon cancer with a metastasis into hepatoma].

A rare case of a colon cancer with a hepatomatous metastasis is reported. A 79 year old female was admitted hospital in April, 1988 with liver cirrhosis. On death in November, 1988, an autopsy revealed a primary, linitis plastica type diffuse adenocarcinoma of the total colon with an extensive metastases into lungs, kidneys, liver, small intestine, bladder, spleen, the bone marrow, and the lymph nodes. In the cirrhotic liver two hepatomatous nodules were found. As a focus of one of these nodules, there was a metastatic linitis plastica lesion of the colon.

Adenocarcinoma, Scirrhous↗
PubMed1990

[Clinicopathological and immunohistochemical study on penetrating and superficial spreading type of early gastric cancers].

Specific type of early gastric cancer based on the cancer surface area and the degree of invasion were studied by measuring digital values of the cancer surface area in early gastric cancer patients. The results indicated that the pen and super type of early gastric cancer had many clinicopathological characteristics as compared with common type of early gastric cancer. An immunohistochemical study also revealed that the pen type of early gastric cancer had a high growth activity. Moreover, it was suggested that EGF was involved in its specific invasion and growth, and that EGF and TGF-beta affected its scirrhous growth. The possibility that the poorly differentiated pen type is an early lesion of linitis plastica type gastric cancer was also considered. From these findings, it was assumed that the immunological staining of EGF and TGF-beta in biopsy specimens might be useful in the diagnosis of the pen type of early gastric cancer and also in diagnosis of early lesion of linitis plastica type gastric cancer.

Epidermal Growth Factor↗
PubMed1999

[Sarcoidosis gastropathy: diagnosis and contribution of echo-endoscopy].

We report a case of gastric sarcoidosis in a 36-year old woman. The clinical and endoscopic ultrasonography findings initially suggested linitis plastica. Subsequently the discovery of unexpected gastric and then, bronchial granulomas after bronchoscopy and bilateral ocular fixation on gallium scanning, led to the diagnosis of sarcoidosis. Endoscopic ultrasonography showed abnormal hypertrophy of the third hyperechoic layer. These findings usually suggest among the etiologies of giant gastric folds, malignant diseases and particularly linitis plastica.

Adult↗
PubMed1998

Metastatic gastric cancer arising from breast carcinoma: endoscopic ultrasonographic aspects.

Linitis plastica of the stomach was diagnosed in four patients. Endoscopic ultrasonography (EUS) was performed in four cases; they were monitored by EUS and had their treatment adapted accordingly. According to the present study, the typical criteria of gastric linitis at EUS are: (a) rigidity of the gastric wall; (b) a wall thickness exceeding 6 mm; (c) a second enlarged layer marginally more echogenic than the fourth hypoechogenic layer (muscularis propria); (d) a third hyperechogenic enlarged layer; and (e) a poor demarcation between layers. Gastric linitis appears more likely to be specific metastasis from lobular breast carcinoma. In most of the follow-up cases, EUS showed correlation with a subsequent decrease of the CA15.3 level. At present, EUS seems to be the most effective and least invasive examination for clinical diagnosis and treatment surveillance of secondary gastric linitis arising from infiltrating lobular carcinoma (ILC) of the breast.

Aged↗
PubMed1986

Gastric carcinoma: 30-year review.

The records of 1030 patients with gastric carcinoma seen between 1941 and 1970 were analysed. A 10-year follow-up was available for 1024. The overall operability and resectability rates were 80.9% and 53.5% respectively, and in the two decades 1951 to 1960 and 1961 to 1970, the rates increased significantly, as did the subtotal gastrectomy rate of 46.9%. Subtotal resection for cure was done in 59.5%, and for palliation in 40.5%. Fifty-six patients underwent a total gastrectomy. There was no significant increase in consecutive decades in either overall 5-year survival or survival following subtotal gastrectomy. The 5- and 10-year survival rates of 15.1% and 6.6%. Of the 5-year survivors, 54% had no lymphnode involvement and 35.2% had nodes positive for tumour spread. Gastroesophagectomy was associated with a high morbidity and extremely low survival. Of 56 patients having a total gastrectomy, 37 lived 1 year or more while only 5 survived 5 or more years. Linitis plastica occurred with equal frequency in men and women. Operability and resectability rates were lower and there was a 90.6% 1-year death rate.

Adult↗
PubMed1996

[Primary signet ring cell adenocarcinoma of the bladder. Report of 2 cases of bladder plastic linitis].

OBJECTIVES: Two additional cases of signet-ring cell adenocarcinoma of the urinary bladder, an uncommon highly malignant tumor type, are described. METHODS/RESULTS: The clinical features, histopathological findings and immunohistochemical study are presented. CONCLUSIONS: Both cases previously had cystic glandular cystitis, which supports the totipotent urothelium origin of this neoplasm. Signet-ring cell adenocarcinoma or linitis plastica of the bladder has a highly malignant course despite neoadjuvant chemotherapy and total cystectomy.

Carcinoma, Signet Ring Cell↗
PubMed2001

Gastric linitis adenocarcinoma and carcinomatous meningitis: an infrequent but aggressive association--report of four cases.

Carcinomatous meningitis (CM) is a very rare complication of gastrointestinal malignancies and especially gastric adenocarcinoma. Linitis plastica (LP), which is a specific form of gastric neoplasia, locally penetrates through the gastric wall to reach the peritoneum. Lymph node involvement is frequent and metastatic sites are almost exclusively observed in the abdominal cavity. The meningeal localization is extremely rare with only a few cases described in the literature. We report here, over a five-year period, four cases of CM on a total of eighty linitis cases diagnosed and treated in our institution, which represent 5% of a non selected linitis population. The clinical manifestations were clearly poor, and characterized by aspecific neurological signs. The diagnosis was made by the discovery of signet cells in the cerebrospinal fluid. Invasive treatment, consisting of intrathecal infusion of chemotherapy, was undertaken with mixed clinical response and no cytological normalization of the cerebrospinal fluid (CSF). In conclusion, our observation which is based on a large series of successive gastric linitis, demonstrates a 5% frequency of developing CM with a predominance among metastatic patients. Furthermore, the diagnosis of CM must be done as soon as possible because of the clear effectiveness of a therapeutic approach on the improvement of symptoms and quality of life.

Antimetabolites, Antineoplastic↗
PubMed1996

An 82-year-old woman with carcinomatosis.

An 82-year-old woman with breast carcinoma died with carcinomatosis, confirmed at autopsy. An unexpected finding was the "linitis plastica" aspect of the stomach, resulting from diffuse tumor infiltration. The coexistence of two different primary tumors was ruled out with data obtained by immunohistochemistry and presented at Tulane Pathology Grand Rounds.

Aged↗
PubMed2003

[Gastric and colonic sarcoidosis. A case report].

Sarcoidosis is a disseminated disease defined by the presence of non-caseous granulomas. Digestive localizations are rare and the stomach is the mostly affected. The diagnosis is frequently difficult. We report the case of a digestive (gastric and colic) and hepatic sarcoidosis in a 38-year old woman. The clinical and endoscopic findings initially suggested linitis plastica. Subsequently the discovery of gastric granulomas led to the diagnosis of sarcoidosis. Coloscopy and abdominal scan were performed discovering a colic, hepatic and splenic localizations which were asymptomatic.

Adult↗
PubMed2006

[Gastric amyloidosis mimicking malignancy. A case report].

Amyloidosis is an abnormal extracellular deposition of insoluble proteins, which is associated with an involvement of the gastrointestinal tract in 50 to 70% of cases. In primary amyloidosis (light chain amyloidosis), localized gastric involvement is a rare finding which can mimic malignancy. We report the case of a 56-year-old man, admitted with upper digestive outlet obstruction. Linitis plastica with lymph node involvement was suspected by gastroscopy, barium meal and endoscopic ultrasonography but was not confirmed by gastric biopsies. The patient was treated with total gastrectomy with lymph node dissection. Pathological examination demonstrated gastric and lymph nodes amyloidosis and no malignant tumor was found. The patient died 9 months later from cardiac failure due to amyloidosis.

Amyloidosis↗
PubMed1996

A review of carcinoma of the stomach at a tertiary care referral hospital.

BACKGROUND: Carcinoma of the stomach continues to cause a significant mortality in the United States. We reviewed the characteristics, treatment modalities, and survival of a group of patients with this cancer at a tertiary care referral hospital. MATERIALS AND METHODS: A retrospective computer based review of all patients with a diagnosis of carcinoma of the stomach in the Ohio State University (OSU) tumor registry was made. One hundred ninety-two analytical cases were found and the data was entered into a computerized database and analyzed. RESULTS: The overall median survival in this series of patients is 10 months with a median survival of 16 months (n.s.) in patients who underwent curative surgery (50% of the patients). There was an increased number of cardia lesion (37%) predominately in male patients (P < 0.05). A significantly greater number of female patients presented with linitis plastica and male patients with adenocarcinoma, although there was no difference in the operability, types of operations, and survival between the genders. Patients with signet ring cell cancer were significantly younger than the other two histological types reviewed but this did not alter outcome. CONCLUSION: Carcinoma of the stomach, despite newer image modalities, continues to present at advanced stages at time of diagnosis with an overall dismal prognosis. The increased incidence of cardia lesions noted require innovative therapies if any progress is to be made.

Adenocarcinoma↗
PubMed1991

Total gastrectomy for advanced cancer. A worthwhile palliative procedure.

Subtotal gastric resection usually provides the best palliation in advanced gastric cancer; however, if total gastrectomy (TG) is required there is doubt about its benefit. The authors reviewed 53 consecutive patients undergoing TG for advanced gastric adenocarcinoma between 1980 and 1989. Indications for TG were tumor location in 30% and extent of tumor in 70%, including nine patients (17%) with linitis plastica. Four patients (8%) died postoperatively, and six patients required reoperation for postoperative complications. The median postoperative hospital stay was 13 days. The median survival was 19 months, and 13 patients (24%) lived for more than 2 years. The quality of life was graded in survivors as good in 59%, satisfactory in 28%, and poor in 13% of patients. It was concluded that TG is a worthwhile procedure for selected patients, even in the presence of advanced disease, providing prolongation of good quality of life with low morbidity and mortality.

Adenocarcinoma↗
PubMed2004

Novel models for human scirrhous gastric carcinoma in vivo.

Human scirrhous gastric carcinoma, a diffusely infiltrating type of poorly differentiated gastric carcinoma also known as linitis plastica type carcinoma, is characterized by cancer cell infiltration and proliferation accompanied with extensive stromal fibrosis. We established two new gastric cancer cell lines, designated OUCM-8 and OCUM-11, which developed the characteristic biology of scirrhous gastric carcinoma upon orthotopic implantation in mice. Involvement of lymph nodes and liver metastasis was also found in both orthotopic models. Histologically, these orthotopic models showed proliferation with extensive fibrosis, resembling human scirrhous gastric cancer. Both cell lines were derived from ascites of patients with scirrhous gastric cancer. The growth of OCUM-8 and OCUM-11 cells following the addition of KGF, FGF, and EGF was increased significantly relative to untreated cells. An increase in the number of attached and spreading cells occurred following the addition of TGF-beta 1 in both cell lines. OCUM-11 cells showed microsatellite instability. Although subcutaneous scirrhous gastric cancer cells show medullary growth, most in vivo studies of scirrhous gastric cancer have used xenografted tumors implanted subcutaneously. Only in a few cases was it confirmed that these scirrhous gastric cancer cell lines retained the original histologic characteristics. Our orthotopic models should contribute to the elucidation of disease progression in situ and to the development of therapy for scirrhous gastric cancer.

Animals↗
PubMed2005

Epidemiology and long term survival of gastric carcinoma in the French district of Finistere between 1984 and 1995.

OBJECTIVES: The aims of this study were to evaluate trends in incidence, clinical characteristics, treatment regimen and prognosis of gastric carcinoma in the area of Finistere (France) during a 12-year period. METHODS: Between 1984 and 1995, the Finistere Registry of GastroIntestinal Tract Tumors listed 2 139 patients with gastric carcinoma in a population of 838 627 inhabitants. Curative resection and operative mortality were analyzed by logistic regression. Prognostic factors were determined using the Kaplan-Meier method and the Cox model. RESULTS: When comparing the second period (1990-1995) to the first period (1984-1989) we observed: a) a decrease of standardized incidence (13.2 vs. 15.6/100 000 inhabitants/year in males and 5.4 vs. 7.0/100 000 inhabitants/year in females); b) a significant increase of linitis plastica (21.4% vs. 10.9%) and infiltrative tumors (53.1 vs. 31.2%) (P<0.0001); c) no variation in tumor stage at diagnosis; d) a significant increase in curative resection (65.7% vs. 45.0%; P<0.0001); e) no variation in operative mortality; f) the absence of improvement of survival rate; the latter was 29% at 2 years, 19% at 5 years and 11% at 10 years during the second period. Multivariate analysis showed that the main prognostic factors of gastric carcinoma were age, tumor stage and the type of surgical procedure. CONCLUSION: This study showed a decrease in the incidence of gastric carcinoma over time and an increase of linitis plasticia and infiltrative forms. Despite improvement in management of patients, the global prognosis of gastric carcinoma did not improve significantly over a 12-year period of observation.

Adult↗
PubMed1975

Membranous glomerulonephritis. An initial symptom of gastric carcinoma?

A 51-year-old man was hospitalized and operated on for gastric carcinoma with widespread metastases and died two months after the laparatomy and biopsy examination. Two years prior to the operation, he deveoped nephrotic syndrome. Anaplastic carcinoma, linitis plastica form, of the stomach was found in the tumor biopsy examination and at autopsy. Light and electron microscopical studies of the kidney biopsy specimen taken at laparatomy confirmed the presence of membranous glomerulopathy. An immunologic basis of the concomitant appearance of malignant neoplasms and nephrotic syndrome is possible, based on reported cases. There is also a possibility that renal damage occurs more commonly in malignant neoplasms, but is not recognized clinically.

Carcinoma↗
PubMed1989

Gastric adenocarcinoma. A disease in transition.

Two hundred eleven gastric adenocarcinomas diagnosed from 1967 to 1982 were analyzed. Thirty-four percent had a proximal location, a proportionate increase from previous decades that suggested a distinctive epidemiology. Diffuse histology occurred in 49% of cases overall and in 55% of unresectable cases, which were also increases from previous decades. No deaths followed curative resections, two (4%) of 50 patients with palliative resections died, and three (6%) of 54 patients who underwent exploration without resection died, indicating improved operative management. Superficial gastric cancer constituted 6% of cases; 91% were cured. Seventeen percent of cases were linitis plastica and required total gastrectomy in 77% of resections; only 13% of patients had curative operations; none were cured. Seventy-nine percent of cases were polypoid or ulcerated focal cancers. Of operable focal cancers, 72% were resected; 27 (47%) of 57 patients who underwent resection for cure survived five years, a distinct improvement from previous reports, as was the overall survival of 21%.

Adenocarcinoma↗
PubMed1983

Primary signet-ring carcinoma of the colon.

Three cases of primary signet-ring carcinoma, or linitis plastica, of the colon are described. This rare form of colonic carcinoma possesses certain clinical, pathologic, and biologic characteristics that differ from those of the ordinary colorectal adenocarcinoma. Most importantly, the prognosis is poor, with only very few patients surviving more than one year following diagnosis. Some authors believe that the poor prognosis seen with this tumor may be due largely to a delay in diagnosis. Therefore, awareness of this form of colonic malignancy should be stressed so that early recognition may be made at a stage when curative treatment can still be instituted.

Adenocarcinoma, Mucinous↗