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PubMed1998

Lethal pulmonary hypertension in a young woman caused by unrecognized haemangiosis carcinomatosa.

A 38-year-old female is described, who was admitted with increasing respiratory distress, cough and visible blood stasis in the jugular veins. The most likely diagnosis in this young women taking oral contraceptives was pulmonary embolism, however, a ventilation-perfusion lung scan was normal. Echocardiography showed a dilated right ventricle and increased systolic pulmonary pressure. Despite administration of oxygen and intravenous heparin the patient died in circulatory collapse before further investigations could be initiated. Post-mortem examination revealed diffuse adenocarcinoma of the stomach (linitis plastica) with metastasis to local lymphnodes, lymphangiosis carcinomatosa of the liver, pancreas and spleen and tumour cell masses within the lumen of small pulmonary arteries leading to variable occlusions of the vessels. Fibrocellular intimal proliferation was found, leading to further obstruction and increased resistance to flow through the pulmonary vascular bed and to subacute cor pulmonale.

Adenocarcinoma↗
PubMed2000

Surgical treatment of gastric cancer invading the oesophagus.

INTRODUCTION: There is controversy regarding which type of surgical treatment is most appropriate for upper gastric cancer invading the oesophagus. METHODS: A review of the pertinent literature was carried out regarding oesophageal involvement in gastric cancer. RESULTS: Invasion of the oesophagus occurred in 26-63% of Western surgical series. It was more frequent in Borrmann IV type, linitis plastica, pT3-pT4, diffuse type by Lauren, N+ or tumours exceeding 5 cm in diameter. Lymphatic tumour spread was caudad (coeliac nodes, hepatoduodenal nodes, paraortic nodes) but mediastinal nodes were also involved if tumour growth in the oesophagus exceeded 3 cm or if there was transmural oesophageal infiltration. In Western countries there was less than 30% 5-year survival and no long-term survivors when hepatoduodenal or mediastinal nodes were metastatic. Mediastinal dissection through thoracotomy did not provide any benefit. CONCLUSIONS: A rational approach involves total gastrectomy plus partial oesophagectomy. Abdominal transhiatal resection may be performed in the case of a localized, non-infiltrating tumour and oesophageal involvement <2 cm. However, infiltrating, poorly differentiated or Borrmann III-IV tumours require a right thoracotomy to achieve a longer margin of clearance. When oesophageal involvement is >3 cm, or hepatoduodenal or mediastinal nodes are positive, no surgical procedure is curative and the literature demonstrates that extended aggressive surgery has no benefits.

Esophageal Neoplasms↗
PubMed1975

[Radiological features of the rectal manifestations of myelofibrosis(author's transl)].

In addition to the well known changes in bone structure, myelofibrosis can result in extramedullary tumour formation; in the gastr-intestinal tract, proliferation of reticulum can lead to fibrotic changes. This results in appearances similar to linitis plastica or Crohn's disease. In the discussion, the authors refer to tumours in other organs which have been described in the literature and which can be demonstrated radiologically.

Autopsy↗
PubMed1988

[Segmental colonic stenosis in intestinal metastasis of breast carcinoma. A contribution to the differential diagnosis of colitis].

Four years after mastectomy for a scirrhous carcinoma a 71-year-old woman developed diarrhoea. Crohn's disease was suspected. At endoscopy a stenosis of the sigmoid colon was found which could not be passed: the mucosa was normal looking. Gastrointestinal radiography revealed segmental subtotal stenoses of the colon with linitis plastica, typical for tumour-caused infiltration, as well as indentations in the small intestine by mesenteric metastases. The diagnosis was confirmed by computed tomography and, finally, operation. Chemotherapy failed to produce any regression of the colon stenoses, and the patient died from mechanical ileus. In case of a similar history and colon stenoses of uncertain aetiology the possibility of intestinal metastases should be considered in the differential diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed2004

Radiological spectrum of late sequelae of corrosive injury to upper gastrointestinal tract. A pictorial review.

PURPOSE: To evaluate the radiological spectrum of sequelae of corrosive acid and alkali injury to the upper gastrointestinal (GI) tract using barium contrast examination. MATERIAL AND METHODS: Barium contrast radiographic films of 155 patients with a history of corrosive ingestion, acid in 120 and alkali in 35 patients with grade 2b and 3 injury on initial endoscopy, were retrospectively evaluated. Barium contrast examination of the upper GI tract was performed in the course of follow-up, beyond 3 weeks of corrosive ingestion. RESULTS: The esophagus was involved in 131 patients and the stomach in 74. Fifty patients had simultaneous involvement of esophagus and stomach. Radiological findings in the esophagus were solitary or multiple strictures of varying length, intramural pseudodiverticula, and carcinoma in long-standing corrosive injury. The stomach showed cicatrization, predominantly involving the antrum, linitis plastica type deformity with multiple pseudodiverticula. There was no difference in the radiological findings as to the type of corrosive ingested. CONCLUSION: Barium examination of the upper GI tract is useful in the evaluation of late sequelae of corrosive injury (acid/alkali). There was no difference in the radiological findings as to the type of corrosive ingested. Thus, contrary to general belief, we found that acid and alkali damage both the esophagus and the stomach with equal degree of severity.

Acids↗
PubMed1989

Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study.

In a multicentric trial the postoperative mortality and the 5-year survival of elective total gastrectomy (TG) was compared with subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study; 32 were excluded after pathologic examination (linitis plastica, superficial cancer, lymphoma). One hundred sixty-nine patients remained for analysis, with 93 undergoing TG and 76 undergoing SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1989

Crohn's disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease.

We have reviewed eight cases of Crohn's disease associated carcinoma (CDAC) of the bowel treated at Saint Barnabas Medical Center since 1977. Five patients had colorectal carcinoma in areas of dysplasia within histologically recognizable Crohn's disease. One of the large bowel carcinomas was a diffusely infiltrating signet ring adenocarcinoma (linitis plastica), three were mucinous carcinomas, and one contained both cell types. Survival ranged from 4 to 55 months. Three patients developed ileal carcinomas in areas of dysplasia within histologically recognizable Crohn's disease. One of the ileal cancers was a moderately differentiated adenocarcinoma; two were poorly differentiated adenocarcinomas. Survival ranged from 8 to 44 months. The dysplastic changes seen in the bowel adjacent to the tumors in these patients were identical to the characteristic pre-cancerous (dysplastic) changes well described in ulcerative colitis. The histopathologic changes seen in this high-risk group of patients are also similar to those of previously reported CDAC. Those patients with the more diffuse dysplastic changes might have been detected before the development of invasive cancer had they undergone periodic colonoscopic surveillance. One patient in the series with an asymptomatic lesion was, in fact, identified at surveillance colonoscopy. It would appear that Crohn's disease patients have a similar risk for carcinoma previously recognized in ulcerative colitis patients and that surveillance protocols should be developed for this group of patients.

Adenocarcinoma↗
PubMed1992

Diseases of the intestine mimicking Crohn's disease.

We describe five patients who were initially thought to have Crohn's disease and were treated accordingly. The original diagnosis was based upon clinical presentation, roentgenograms, and histological examination, but subsequent follow-up showed that diagnosis to be in error. The following diagnoses were established instead: tuberculosis, Actinomyces Israeli infection, reaction to gold therapy, metastatic cancer, and linitis plastica. We stress the importance of considering conditions that can mimic Crohn's disease.

Actinomycosis↗
PubMed1987

Adenocarcinoma of the stomach: are we making any progress?

We studied 2,062 patients with adenocarcinoma of the stomach seen at The University of Texas M. D. Anderson Hospital and Tumor Institute between 1944 and 1984. The distribution by site was cardia 33%, antrum 31%, and body 27%; 9% of the patients had linitis plastica. The raw five-year survival rate was 12.5%; surgically treated patients with negative nodes had a five-year survival rate of 75%, compared to 19% for those with positive nodes. Forty-one percent of patients had diagnostic procedures only, 35% had a Billroth I or II gastrectomy, and 24% had total gastrectomy or radical proximal gastrectomy. In the first decade fewer than one new patient per week was registered, but this has increased to more than two during the last decade. This apparent increase is due to the 65% of patients referred for palliative chemotherapy. Improved nutritional support has made operations safer and combined with chemotherapy has provided modest progress.

Adenocarcinoma↗
PubMed1989

Total gastrectomy for gastric carcinoma.

We retrospectively analyzed experience with total gastrectomy (TG) for gastric carcinoma in 23 patients. The TNM stage was I in one patient, II in one patient, III in eight patients, and IV in 13. Linitis plastica was found in ten patients. The operation was considered curative in only eight patients (35%). There were 13 complications in eight patients. There were no operative deaths. The survival ranged from three to 36 months. The survival for curative TG was a mean of 21.2 months +/- 3.3 SEM; for palliative TG, mean survival was 10.1 months +/- 1.1 SEM (P less than .001). These results suggest that gastric carcinoma that extensively involves the fundus and/or the corpus continues to be highly lethal, even when these tumors can be resected with a TG. Furthermore, even when the operation is considered "curative" and can be done with little or no operative mortality, the average survival was at best 21 months.

Adenocarcinoma↗
PubMed1979

Gastric carcinoma in dogs produced by the combined use of N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) and gastrin--with special reference to development of scirrhous carcinoma.

Eight beagle dogs of four-month-old received both oral administration of N-Ethyl-N'-Nitro-N-Nitrosoguanidine (ENNG) and subcutaneous injection of gastrin, and one of them was found to have an annularly infiltrating advanced carcinoma with marked fibrous thickening of the antral wall resulting in stenosis of the antrum (carcinoma scirrhosum) which resembled "Linitis plastica" (Borrmann's type IV carcinoma) in human stomach.

Adenocarcinoma, Scirrhous↗
PubMed1985

Difficulties in the endoscopic diagnosis of gastric and oesophageal cancer.

A study was made of 116 patients with gastric or oesophageal cancer, in whom endoscopy was negative, or biopsy was negative or not performed. The most common problems were the presence of pyloric or oesophageal stricture (sometimes with excessive luminal content) and difficulty in obtaining diagnostic biopsy material in linitis plastica, early gastric cancer, lymphoma and sarcoma. Problems also occurred from failure to biopsy apparently benign conditions and from delay in a second endoscopy. Some cancers were regarded as benign ulcers and treated as such by drugs or surgery because more reliance was placed on endoscopic biopsy than on the endoscopist's opinion of the macroscopic appearance. In 17 of the 16 patients there was delay, incorrect management or further difficulty in diagnosis.

Diagnostic Errors↗
PubMed1992

Signet-ring cell carcinoma of the prostate mimicking primary gastric carcinoma.

A post mortem examination of a 70 year old man, who died three years after a poorly differentiated adenocarcinoma of prostate had been diagnosed, showed widespread signet-ring cell carcinoma, with an associated linitis plastica. The signet-ring cells stained positively with prostatic specific antigen and with prostatic specific acid phosphatase, but failed to react with mucopolysaccharide staining. The electron microscopic appearance of the signet-ring cell tumour was due to the presence of large cytoplasmic vacuoles. This case emphasises the possibility that cases of metastatic signet-ring cell carcinoma may be prostatic in origin. This can be confirmed by specific immunohistochemical studies.

Adenocarcinoma, Mucinous↗
PubMed1990

Scirrhous carcinoma of the stomach: radiologic and endoscopic diagnosis.

During a recent 10-year period, scirrhous tumors of the stomach were diagnosed at upper gastrointestinal examinations in 27 patients in whom pathologic correlation was available. Nineteen patients underwent double-contrast studies, and eight underwent single-contrast studies. Twenty-two of the 27 patients had primary gastric carcinoma, four had gastric involvement by metastatic breast cancer, and one had antral gastritis and scarring without evidence of malignancy. Although the involved gastric segment often demonstrated only mild loss of distensibility, the presence of a scirrhous tumor was suggested radiographically by distortion of the normal surface pattern of the stomach with mucosal nodularity, spiculation, ulceration, and/or thickened, irregular folds. Ten patients had localized lesions involving the gastric fundus and/or body rather than the classic form of linitis plastica involving the distal stomach. Furthermore, endoscopy had significant limitations in confirming this diagnosis, as findings from brushings or biopsies were positive for malignancy in only 14 of 20 patients (70%). Radiologists should be aware of the frequent proximal location of these scirrhous tumors and of the problems of endoscopic diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed2001

Upper gastrointestinal bleeding as a metastatic manifestation of breast cancer: a case report and review of the literature.

CASE PRESENTATION: A 64-year-old woman with known metastatic lobular breast cancer presented with fever, epigastric pain, hematemesis, and melena. A bleeding, ulcerated gastric metastasis was found and was treated with endoscopic therapy, omeprazole, and hormonal therapy. The patient was alive and well 13 months later. The bleeding was probably precipitated by necrosis of the lesion during chemotherapy. DISCUSSION: Gastrointestinal tract metastases from primary breast carcinoma are present in 14% to 35% of cases in autopsy series, with gastric involvement in 6% to 18% of cases. Recognized much less commonly during life than in autopsy studies, they can occur anywhere in the gut and can mimic virtually any gastrointestinal disorder. Endoscopy and barium studies facilitate diagnosis. Gastric lesions that have been noted include "linitis plastica", nodules, polyps, and ulcers. They are usually due to lobular breast carcinoma and resemble primary gastric carcinoma on microscopy. Reported cases of bleeding gastric metastases have been treated successfully with various local and systemic modalities. The median survival time of reviewed cases was four months from presentation (with a range of zero to 24 months). CONCLUSIONS: Gastrointestinal metastasis is an underdiagnosed complication of breast cancer. Gastrointestinal bleeding from metastatic breast cancer is an uncommon presentation that is readily diagnosed and that can be treated successfully by endoscopic hemostatic therapy.

Breast Neoplasms↗
PubMed1999

Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma.

Nausea and vomiting in patients with advanced gastric malignancy and mechanical obstruction are distressing and difficult to manage. We describe a patient with linitis plastica and gastric stasis who was treated with a percutaneous endoscopic duodenostomy as the stomach could not be used for percutaneous endoscopic gastrostomy (PEG) formation. A Conflo PEG tube was inserted into the second part of the duodenum using the Ponsky-Gauderer technique without complication. The patient experienced excellent symptomatic relief and tolerated enteral nutrition extremely well, regaining some weight. This manoeuvre can produce effective symptom palliation allowing the patient to be managed at home during the terminal phase of their illness.

Administration, Cutaneous↗
PubMed2004

Metastatic carcinoma of the colon similar to Crohn's disease: a case report.

A 68-year-old Japanese man with a history of linitis plastica carcinoma of the stomach and subsequent gastrectomy 8 years previously presented with lower abdominal pain. Radiological and endoscopic examinations showed multiple submucosal nodular lesions similar to Crohn's disease in the ileocecal area. A firm diagnosis could not be made after initial multiple biopsies. Finally, a submucosal biopsy revealed adenocarcinoma. The ileocecal lesion was diagnosed as a recurrence because of the histological findings, which included mucosal preservation, a similarity with the histologic type of stomach carcinoma, and atypical immunoreactivity for primary colon carcinoma; the lesion was negative for both cytokeratin 7 and cytokeratin 20. In cases where metastatic carcinoma of the colon is suspected, we recommend early consideration of a submucosal biopsy.

Adenocarcinoma↗
PubMed1995

CT in patients with scirrhous carcinoma of the GI tract: imaging findings and value for tumor detection and staging.

OBJECTIVE: The purposes of this study were to analyze the CT features of scirrhous carcinoma of the gastrointestinal (GI) tract and to assess the usefulness of CT in detecting and staging these lesions. MATERIAL AND METHODS: This is a retrospective evaluation of 31 proven cases of scirrhous carcinoma (linitis plastica) of the GI tract imaged in our institution from 1986 to 1994. Twenty-two patients had primary gastric carcinoma, and nine had carcinoma of the colon (rectosigmoid in eight and right colon in one). CT examinations were reviewed and correlated with pathologic and/or surgical findings in all patients and with barium examinations in 19 cases. A modified Dukes classification was used to stage these lesions without knowledge of the pathologic and surgical results. RESULTS: Four gastric lesions were missed during the initial CT examination. Seventeen patients had extensive circumferential lesions, and five had focal plaquelike lesions. The wall thickness ranged from 1 to 3 cm (mean, 1.8 cm). Homogeneous enhancement was seen in 17 patients, slightly heterogeneous enhancement was seen in one, a target configuration was present in two patients, and intramural calcification was present in one patient. All colonic lesions were circumferential, homogeneously enhancing with a wall thickness ranging from 1 to 3 cm (mean, 2 cm). CT scans showed limitations in evaluating local parameters. Compared with surgical and pathologic staging, CT correctly staged 26 patients, understaged four patients, and overstaged one patient. Among the 19 patients with pathologically proven stage D lesions (61%), CT correctly staged 17 patients (89%) and had a 100% positive predictive value. One case of hepatic metastases, 13 cases of malignant ascites, and 11 cases of omental and peritoneal metastases were found. CONCLUSION: CT is an important complimentary imaging technique to detect scirrhous carcinoma. The sensitivity of detection depends on the size of the lesion and the quality of the examination. CT has limitations in staging early lesions but shows a high sensitivity (89%) in detecting Dukes stage D lesions. Accurate CT staging in these individuals (61% in this series) allows a more adequate treatment strategy and avoids unnecessary exploratory laparotomies.

Adenocarcinoma, Scirrhous↗