Korean J Radiol.  2009 Dec;10(6):645-648. 10.3348/kjr.2009.10.6.645.

Metastatic Gastric Linitis Plastica from Bladder Cancer Mimicking a Primary Gastric Carcinoma: a Case Report

• Hong WS
• Chung DJ
• Lee JM
• Byun JH
• Hahn ST

• KMID: 1102570
• DOI: http://doi.org/10.3348/kjr.2009.10.6.645

Abstract

Primary gastric carcinoma is the most common cause of linitis plastica. Less frequently, metastatic gastric cancer from the breast, omental metastases and non-Hodgkin lymphoma involving the stomach have been reported to show similar radiographic findings as for linitis plastica. A metastatic gastric cancer from bladder cancer is extremely rare. We present an unusual case, the first to our knowledge, of gastric linitis plastica that resulted from a metastatic urothelial carcinoma of the bladder.

Keyword

Matastatic; Linitis plastica; Bladder cancer

MeSH Terms

Diagnosis, Differential
Humans
Linitis Plastica/radiography/*secondary
Male
Middle Aged
Stomach Neoplasms/radiography/*secondary
Tomography, X-Ray Computed
Urinary Bladder Neoplasms/*pathology

Figure

• 

  Fig. 1 Imaging findings are presented for 60-year-old man with underlying bladder cancer presenting as linitis plastica. A. Axial enhanced CT image obtained seven months earlier shows massive bladder wall thickening with slightly heterogeneous enhancement (solid arrows), which was diagnosed as bladder cancer. Bladder mass invaded seminal vesicle, prostate and adjacent pelvic walls (T4). B. 5 mm thick, reformatted coronal image obtained seven months earlier shows no evidence of abnormal wall thickening or focal lesion in stomach. C. 5 mm thick, reformatted coronal image obtained on recent visit to emergency room shows newly noted diffuse gastric wall thickening with dense enhancement and marked perigastric infiltrations (solid arrows). Multiple nodular lesions are noted along transverse mesocolon with diffuse segmental wall thickening in mid portion of transverse colon (arrowheads), suggesting transverse colon invasion. D. Upper GI series shows marked gastric mucosal thickening from lower body to pyloric antrum of stomach (solid arrows). There was abrupt narrowing at gastric antrum with rigidity and loss of peristalsis (arrowhead), producing appearance of linitis plastica. E. Photomicrograph (Hematoxylin & Eosin staining, ×200) of gastric biopsy specimen shows numerous poorly differentiated malignant cells with eccentric nuclei and moderate to abundant cytoplasm. F. Immunohistochemical analysis shows positive staining for p63.

Reference

1. Gore RM, Levine MS. Textbook of gastrointestinal radiology. 2008. 3rd ed. Philadelphia: Saunders;628–649.

2. Kim SY, Kim KW, Kim AY, Ha HK, Kim JS, Park SH, et al. Bloodborne metastatic tumors to the gastrointestinal tract: CT findings with clinicopathologic correlation. AJR Am J Roentgenol. 2006. 186:1618–1626.

3. Menuck LS, Amberg JR. Metastatic disease involving the stomach. Am J Dig Dis. 1975. 20:903–913.

4. Wallmeroth A, Wagner U, Moch H, Gasser TC, Sauter G, Mihatsch MJ. Patterns of metastasis in muscle-invasive bladder cancer (pT2-4): an autopsy study on 367 patients. Urol Int. 1999. 62:69–75.

5. Pak K, Ishida A, Arai Y, Tomoyoshi T. An autopsy case of untreated bladder cancer. Hinyokika Kiyo. 1987. 33:1261–1265.

6. Kanne JP, Mankoff DA, Baird GS, Minoshima S, Livingston RB. Gastric linitis plastica from metastatic breast carcinoma: FDG and FES PET appearances. AJR Am J Roentgenol. 2007. 188:W503–W505.

7. Levine MS, Kong V, Rubesin SE, Laufer I, Herlinger H. Schirrous carcinoma of the stomach: radiologic and endoscopic diagnosis. Radiology. 1990. 175:151–154.

8. Ha HK, Jee KR, Yu E, Yu CS, Rha SE, Lee IJ, et al. CT features of metastatic linitis plastica to the rectum in patients with peritoneal carcinomatosis. AJR Am J Roentgenol. 2000. 174:463–466.

9. Gollub MJ, Schwartz MB, Shia J. Scirrhous metastases to the gastrointestinal tract at CT: the malignant target sign. AJR Am J Roentgenol. 2009. 192:936–940.

10. Kunju LP, Mehra R, Snyder M, Shah RB. Prostate-specific antigen, high-molecular-weight cytokeratin (clone 34betaE12), and/or p63: an optimal immunohistochemical panel to distinguish poorly differentiated prostate adenocarcinoma from urothelial carcinoma. Am J Clin Pathol. 2006. 125:675–681.