A Leathery Lining

Abstract

A 44-year-old previously healthy man from Mexico presented with 10 days of abdominal pain, nausea, and vomiting. The exam was remarkable for decreased left-sided breath sounds, diffuse abdominal tenderness, and mild abdominal distention. Chest radiograph showed a large left pleural effusion. Computed tomography of the abdomen demonstrated a markedly thickened stomach wall, loculated peritoneal fluid collections, paraaortic lymphadenopathy, and omental carcinomatosis (Fig. 1). Thoracentesis was performed and cytopathological examination of the pleural fluid showed a poorly differentiated adenocarcinoma of upper gastrointestinal origin. Esophagogastroduodenoscopy revealed a diffusely thickened and rigid stomach indicating extensive intramural malignant infiltration consistent with “linitis plastica” (Fig. 2); gastric biopsy confirmed diffuse-type gastric adenocarcinoma. Figure 1. Computed tomography of the abdomen showed a thickened stomach wall (green arrow), a loculated fluid collection (blue arrow), paraaortic lymphadenopathy (yellow arrow), and omental carcinomatosis (red arrow). Figure 2. Esophagogastroduodenoscopy revealed a diffusely thick and rigid stomach consistent with linitis plastica. Originally coined by William Brinton in 1854, linitis plastica, also known as leather bottle stomach, accounts for 3–19 % of all gastric cancers, and portends a poor prognosis.1,2 A case series of 86 patients reported 1-year and 7-year survival rates of 50 % and 8 %, respectively, despite surgical resection.3 In this case, the inelasticity of the patient’s stomach resulted in intractable nausea and vomiting, for which a nasogastric tube was inserted for as-needed suctioning. Given the extent of his tumor burden, the patient was treated with symptomatic management and transitioned to home hospice.