In this EUS Learning Series, the next step is Linitis Plastica. A 55 year old man is referred for evaluation of gastric cancer diagnosed at an outside facility. He had undergone EGD, EUS and probe sonography; a diagnosis of Linitis Plastica was made. We would like to show stomach anatomy in health and in Linitis Plastica to appreciate the features. Anatomy of normal stomach: here you can see a nicely contracting antral wave of peristalsis going through the antrum, and a wide open antrum with normal mucosa, without any ulceration and wide open pylorus. Compared to this, look at the endoscopic picture of linitis plastica, where the antrum is thickened, the mucosa does not show any ulceration, but it was stiff and one needed to push the scope through the stiffened antrum all the way to the pylorus. Here is the opening of the pylorus and the duodenum, and you could see stiffened antrum. Let us look at the EUS of the antrum, nice 4 layered structure as you can see here. Compare this with the EUS of Linitis Plastica using a radial echoendoscope. Notice the thickening of the antral muscular wall and the mucosal and submuocosal layers here. Let us look at these in slightly more detail. There is thickening of the wall of the antrum, thickening of the submucosa and thickening of the muscularis propria. These features could be better defined using a probe sonography under water immersion. Let us look at these features again. High frequency probe sonogaphy of the antrum reveal thickened wall of the stomach, thickened submucosa and muscularis propria. Biopsies reveal signet cell adenocarcinoma. In summary, we demonstrated endoscopic features of Linitis Plastica, along with EUS features and hisological features.
Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Sathya Jaganmohan, MD, University of Texas Medical Branch
Jeffrey H. Lee, MD, MD Anderson Cancer Center