Linitis plastica of the bowel secondary to disseminated transitional cell carcinoma: post-mortem case report and literature review

Abstract

We present the post-mortem case of a 71-year-old female admitted with persistent nausea, vomiting and diarrhoea. Laparotomy revealed multiple small and large bowel strictures. Sigmoidoscopy demonstrated a rectal stricture with ‘cobble-stoned’ mucosa. The clinical differential diagnosis included a possible infective, inflam-matory or neoplastic disease process. However rectal endoscopic biopsies showed undifferentiated carcinoma with malignant cells diffusely infiltrating submucosa and muscularis propria. Past medical history included a bladder urothelial carcinoma resection in 2010. Due to the unusual clinical presentation, a post-mortem examination was requested. The autopsy findings confirmed multiple bowel strictures apparently due to concentric fibrosis of muscularis propria, involving the distal jejunum, terminal ileum, transverse colon and rectum, with associated mucosa cobbleston-ing. However, histology showed a diffuse transmural infiltration of malignant tumour cells, with relative mucosal sparing. Immu-nohistochemically, tumour cells stained positive for CK7, CK20, HMWCK and thrombomodulin. Previous bladder histology was reviewed and showed morphologically similar malignant tumour cells. Only a few rare case reports of metastatic bladder carcinoma presenting with features of linitis plastica have been reported in the literature. Case presentation including gross and microscopic pathological findings and detailed literature review will be provided.