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An unusual case of the signet ring cell variant of adenocarcinoma of the bladder occurred in which the tumor extensively infiltrated the bladder wall and perivesical fascia. The pattern of infiltration was analogous to that seen in the linitis plastica variant of gastric carcinoma. Cystoscopic and roentgenographic studies failed to reveal a grossly evident lesion.
A 40-year-old multigravid woman was examined on multiple occasions during pregnancy because of persistent gastrointestinal symptoms. A metastatic, unresectable gastric carcinoma that had evolved to linitis plastica was diagnosed at 26 weeks' gestation. The patient was delivered of a viable infant at 27 weeks' gestation, and she died of disease 1.5 months after the diagnosis was made.
Gastric tuberculosis is rare and usually presents as an ulcerated lesion or gastric outlet obstruction. Rarer presentations include massive gastrointestinal bleed and gastric perforation. A case of gastric tuberculosis presenting as linitis plastica is reported here. This is the first such case report. The patient was a young woman who presented with non-specific abdominal pain and significant weight loss. The gastric mucosa appeared oedematous and hyperaemic and there was spontaneous oozing of blood on upper gastrointestinal endoscopy. Computed tomography of the abdomen revealed diffuse thickening of the gastric wall. The diagnosis was confirmed by the presence of caseating granulomas with acid fast bacilli in the endoscopic biopsy specimen. The patient showed significant clinical improvement on four-drug anti-tuberculous treatment.
The radiological appearances in a patient with gastric sarcoidosis are described. The signs were initially interpreted as neoplastic infiltration but subsequent endoscopy and biopsy established the diagnosis of sarcoidosis. A 5 year follow-up barium meal shows that the appearances are unchanged. In the differential diagnosis of lesions resembling linitis plastica, sarcoidosis should be considered.
Gastric cancer is uncommon in the young. Occasional reports are found in the literature and reviewed here. This article reports a case of a 16-year-old Eskimo girl unusual because of her young age, the presentation with a perforation and the presence of a linitis plastica type involvement. Management was somewhat unique because of the prolonged use of outpatient total parenteral alimentation during her final months of life.
Primary adenocarcinoma represent 0.5 to 2% of all bladder tumours and are classified according to whether or not they are derived from the urachus, although, histologically, this classification now appears to be obsolete. The authors report a very rare case of linitis plastica type of primary signet cell adenocarcinoma of the bladder in a 53-year-old patient. This carcinoma, with very unusual histological features, needs to be distinguished. Due to the delayed diagnosis, it has a poor prognosis despite the most aggressive treatment modalities, as reported in the literature. The elevated CA 19-9 observed in the present case may be a useful marker for follow-up.
Two cases of primary linitis plastica of the large intestine will be presented and discussed. Characteristic clinical features of this type of adenocarcinoma of the large intestine include younger age of presentation, low incidence of hepatic metastasis and a high incidence of ovarian, lymph node and peritoneal metastasis. Pathological features reveal thickening of the intestinal wall by diffuse infiltrating tumor cells of the characteristic signet ring cells, abortive glands and undifferentiated or anaplastic cells. The prognosis is poor.
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Childhood malignant neoplasms of the gut are extremely rare. The reported incidence of colorectal cancers in patients under 20 years of age is 1 in 10 million. The low index of suspicion for this tumour in children results in advanced disease at diagnosis and subsequently a poor prognosis. A rare case of a primary linitis plastica of the rectum occurring in a 13 year old boy is reported with review of pertinent literature.
Two patients, 60 and 62 years old, were admitted with progressive dysphagia and weight loss of 8 to 12 weeks duration. Radiographic studies revealed an area of stenosis in the lower third of the esophagus in both cases. Endoscopic and biopsy findings established the diagnosis of a neoplasm, with malignant signet ring cells infiltrating the mucosa. Partial esophagogastrectomy in both cases disclosed an infiltrative adenocarcinoma of the lower esophagus, without involvement of the gastroesophageal junction. One of the patients had metastases to regional lymph nodes; the other patient has no clinical evidence of recurrence 14 months after surgery. Endoscopic, radiologic, and pathologic findings are consistent with the diagnosis of linitis plastica of the esophagus.
A 59-year-old woman was admitted to our hospital complaining of weight loss. Fourteen years earlier, she had undergone gastrectomy for gastric carcinoma of the Borrmann III type on the lesser curvature of the body. Biopsy specimens of the lesion revealed poorly differentiated adenocarcinoma. On the fifth hospital day of the admission under study, she complained of vaginal bleeding, and a diagnosis of endometrial carcinoma was made by a gynecologist. Transverse colectomy and total hysterectomy were done. The lesion was localized only in the transverse colon, was histologically poorly differentiated adenocarcinoma similar to the specimen of gastric carcinoma resected 14 years earlier and involved mainly the serosa. Therefore, secondary linitis plastica of the transverse colon was diagnosed.
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Signet ring cell adenocarcinoma of the bladder is a rare tumor that usually presents as a diffuse and infiltrating neoplasm, similar to the linitis plastica type of gastric adenocarcinoma. We report the thirteenth case of primary signet ring cell adenocarcinoma of the bladder, which is documented by light microscopic, immunohistochemical and electron microscopic studies. the pertinent medical literature is reviewed and analyzed. In general, this tumor present with hematuria and irritative symptoms, and may yield equivocal radiologic and cystoscopic findings. It is characterized by a rather rapid growth rate, infiltration of the surrounding pelvic organs, and variable response to radiotherapy and radical surgery. The prognosis is apparently favorably modified by early detection of localized forms of the tumor and aggressive treatment.
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