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Labra AA, Schiappacasse G, Cocio RA, Torres JT, González FO, Cristi JA, Schultz M. Secondary rectal linitis plastica caused by prostatic adenocarcinoma - magnetic resonance imaging findings and dissemination pathways: A case report. World J Radiol 2024; 16:473-481. [PMID: 39355383 PMCID: PMC11440266 DOI: 10.4329/wjr.v16.i9.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer. CASE SUMMARY Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum. CONCLUSION Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.
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Affiliation(s)
- Andres Antonio Labra
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Giancarlo Schiappacasse
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Rolando Alfonso Cocio
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Jorge Tomás Torres
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Fernando Omar González
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Joaquin Alberto Cristi
- Department of Radiology, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7650568, Región Metropolitana, Chile
| | - Marcela Schultz
- Department of Pathology, Clínica Alemana de Santiago, Santiago 7650568, Región Metropolitana, Chile
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Mommersteeg MC, Kies DA, van der Laan J, Wonders J. Linitis plastica of the rectum secondary to prostate carcinoma. BMJ Case Rep 2022; 15:e248462. [PMID: 36460309 PMCID: PMC9723822 DOI: 10.1136/bcr-2021-248462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Linitis plastica is an intramural carcinoma that may occur in any hollow organ. Rectal linitis plastica (RLP) is a morphological variant cancer that may occur as a primary form of cancer or secondary as a metastasis of a primary malignancy. We report the case of a man in his 70s with RLP secondary to prostate carcinoma who was initially suspected to have an obstructing rectal adenocarcinoma. During colonoscopy a segment of cobblestone mucosa was seen in the distal rectum. Subsequent imaging showed enhancement of all wall-layers of the rectum and diffuse retroperitoneal fat infiltration with traction on both ureters. A prostate-specific membrane antigen scan confirmed RLP secondary to a prostate carcinoma mimicking the clinical and radiological signs of an obstructing rectal carcinoma with retroperitoneal fibrosis.This case emphasises the possible pitfalls in the diagnosis of RLP and the importance of advanced imaging techniques, such as MRI, as well as appropriate histological samples. The patient underwent androgen deprivation therapy to which RLP responded well and neither systemic chemotherapy or surgery was necessary.
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Affiliation(s)
- Michiel C Mommersteeg
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
| | - Dennis A Kies
- Department of Radiology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
| | - Jaap van der Laan
- Department of Pathology, HagaZiekenhuis Locatie Leyweg, Den Haag, Zuid-Holland, The Netherlands
| | - Janneke Wonders
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
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Tunio MA, Agamy AM, Fenn N, Hanratty D, Williams NW. An unusual delayed rectal metastasis from prostate cancer masquerading as primary rectal cancer. Int J Surg Case Rep 2022; 100:107732. [PMID: 36252546 PMCID: PMC9574773 DOI: 10.1016/j.ijscr.2022.107732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance Rectal metastasis of prostate cancer origin is exceedingly rare. Its clinical presentation, endoscopic morphology, and histopathology are similar to primary rectal cancer. Misdiagnosis may lead to inappropriate treatment. Case presentation We report a case of a gentleman in his 80's with a history of treated prostate cancer T3aN0M0 with radical prostatectomy sixteen years ago. He presented with one-year complaints of altered bowel habits and weight loss. Physical and rectal examination was unremarkable. Colonoscopy manifested some inflammatory changes in the rectum. The pelvis magnetic resonance imaging (MRI) showed an abnormal posterior rectal wall thickening 2 cm above the anal canal. Biopsy confirmed poorly differentiated adenocarcinoma of prostate origin. The staging workup was negative for other distant metastasis. After a multidisciplinary decision, the patient was started on androgen deprivation therapy and given palliative radiotherapy to the rectum. Six weeks later, the patient was stable with mild radiation proctitis. Clinical discussion Management of rectal metastasis varies depending on the patient's choice, the extent of metastatic burden, symptoms, age, life expectancy, quality of life and comorbidities. While surgery remains the standard of care, other option including radiotherapy, hormonal therapy and chemotherapy has been documented in the literature with survival of few weeks to 2 years. Conclusion Delayed rectal metastasis of prostate cancer after radical prostatectomy is a rare entity. Its clinical presentation and endoscopic and histopathological findings of rectal metastasis are similar to primary colorectal cancer, making diagnosis more demanding.
Rectum is a rare isolated site of metastasis from prostate cancer. Symptoms and endoscopic morphology of rectal metastasis are similar to primary rectal cancer. Prostate-specific antigen is not always raised in rectal metastasis. Emergent lower gastrointestinal symptoms in patients with a history of prostate cancer warrants a multidisciplinary approach to reach an accurate diagnosis and prompt treatment. Management of rectal metastasis depends on patient desire, the severity of symptoms, age, quality of life, life expectancy and comorbidities.
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Affiliation(s)
- Mutahar Ali Tunio
- Clinical Oncology, Swansea Bay University Health Board, Swansea, UK,Corresponding author.
| | | | - Neil Fenn
- Clinical Oncology, Swansea Bay University Health Board, Swansea, UK,Urology, Swansea Bay University Health Board, Swansea, UK
| | - Daniel Hanratty
- Colorectal Surgery, Swansea Bay University Health Board, Swansea, UK
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Mazza S, Laurenza C, Elvo B, Tanzi G, Ungari M, Soro S, Verga MC, Drago A, Grassia R. Rectal linitis plastica as the first presentation of metastatic lobular breast cancer: an endoscopic ultrasound diagnosis. Clin J Gastroenterol 2022; 15:1072-1077. [DOI: 10.1007/s12328-022-01690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
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Khor V, Khairul-Asri MG, Fahmy O, Hamid SA, Lee CKS. Linitis plastica of the rectum secondary to metastatic prostate cancer: A case report of a rare presentation and literature review. Urol Ann 2021; 13:442-445. [PMID: 34759661 PMCID: PMC8525488 DOI: 10.4103/ua.ua_188_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/16/2021] [Indexed: 01/18/2023] Open
Abstract
Linitis plastica is a rare tumor with poor prognosis. It is a circumferentially infiltrating intramural tumor which can result in rigid, nondistensible thickening of the affected organ. It most commonly affects the stomach, followed by the rectum, and can be due to primary or secondary cancer. Secondary rectal linitis plastica (RLP) caused by metastatic cancers has been reported from the stomach, breast, gallbladder, urinary bladder, and very rarely, the prostate, with only <5 reported cases in the literature. We report the case of a 66-year-old man who presented with altered bowel habit and loss of weight, with elevated prostate-specific antigen of 180.6 ng/mL. Sigmoidoscopy showed thickened rectal mucosa, and biopsy was negative for malignancy. Magnetic resonance imaging showed circumferential wall thickening, "target sign" appearance suggestive of RLP, PIRADS 5 lesion with extraprostatic extension, infiltrating bilateral seminal vesicles, and right neurovascular bundle. Repeat colonoscopy was performed under anesthesia, and deeper biopsy revealed poorly differentiated metastatic prostate adenocarcinoma. This case report highlights the atypical presentation of metastatic prostate cancer secondary to RLP, the rarity of this condition, and emphasizes the importance of deeper biopsy in RLP due to disease involvement predominantly in the submucosa and muscularis propria layers.
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Affiliation(s)
- Vincent Khor
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia
| | - Mohd Ghani Khairul-Asri
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Omar Fahmy
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Suzana Ab Hamid
- Department of Radiology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Christopher Kheng Siang Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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6
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Janjic O, Labgaa I, Hübner M, Demartines N, Joliat GR. Metastasis to the rectum: A systematic review of the literature. Eur J Surg Oncol 2021; 48:822-833. [PMID: 34656391 DOI: 10.1016/j.ejso.2021.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Metastatic spread to the rectum is a rare finding, and management of rectal metastases (RM) is not standardized. The aim of the present study was to review the evidence on diagnosis, management and outcomes of RM. METHODS A computerized literature search through MEDLINE/PubMed, Embase and the Cochrane databases was performed, applying a combination of terms related to RM. Articles and abstracts were screened and final selection was done after cross-referencing and by use of predefined eligibility criteria. RESULTS Final analysis was based on 99 publications totaling 162 patients with RM from 16 different primary tumors. Most common origins of RM were breast (42 patients), stomach (38 patients), and prostate (16 patients). RM occurred metachronously in the majority of patients (77%). The main treatment was surgical resection (n = 32), followed by chemotherapy (n = 16). Median overall survival for breast RM, stomach RM, and prostate RM were 24 months (95% CI 9-39 months), 7 months (95% CI 0-14 months), and 24 months (95% CI 7-41 months), respectively. CONCLUSION RM is a rare and highly heterogeneous condition. Surgical treatment appears to be a valuable treatment option in selected patients, while overall prognosis depends mainly on the primary tumor.
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Affiliation(s)
- Olivier Janjic
- Department of General Surgery, Münsingen Hospital, Inselgruppe, Bern, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
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7
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Primary rectal linitis plastica: Report of two cases and a review of the literature. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.581349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Blocked by a Ring: A Case of Gastric Linitis Plastica Presenting as Large Bowel Obstruction Secondary to Rectal Stenosis. ACG Case Rep J 2019; 6:e00007. [PMID: 31616715 PMCID: PMC6657991 DOI: 10.14309/crj.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/12/2018] [Indexed: 11/17/2022] Open
Abstract
Metastatic gut lesions from primary gastric carcinoma occur via hematogenous, lymphatic, or peritoneal seeding. We report an unusual case of large bowel obstruction secondary to rectal stenosis due to metastatic signet ring cell gastric cancer. A 61-year-old woman with a history of 8 weeks' duration of alternation in bowel movements presented with symptoms of bowel obstruction. Computed tomography revealed rectal wall thickening, and sigmoidoscopy demonstrated edematous and fibrotic rectal mucosa. Superficial biopsies were negative for malignant disease. Because of worsening of obstructive symptoms, an emergent surgical diversion was performed. Surgical biopsies were consistent with poorly differentiated adenocarcinoma. Gastroscopy established diagnosis of gastric adenocarcinoma with signet ring type cells. Rectal stenosis on examination and demonstration of rectal wall thickening on imaging should raise suspicion for Schnitzler's metastasis, and an upper endoscopy should be performed.
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9
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You JH, Song JS, Jang KY, Lee MR. Computed tomography and magnetic resonance imaging findings of metastatic rectal linitis plastica from prostate cancer: A case report and review of literature. World J Clin Cases 2018; 6:554-558. [PMID: 30397613 PMCID: PMC6212608 DOI: 10.12998/wjcc.v6.i12.554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/03/2018] [Accepted: 08/28/2018] [Indexed: 02/05/2023] Open
Abstract
Linitis plastica is a rare condition showing circumferentially infiltrating intramural anaplastic carcinoma in a hollow viscus, resulting in a tissue thickening of the involved organ as constricted, inelastic, and rigid. While most secondary rectal linitis plastica (RLP) is caused by metastasis from stomach, breast, gallbladder, or bladder cancer, we report an extremely rare and unique case of secondary RLP due to prostate cancer with computed tomography (CT) and magnetic resonance imaging (MRI) findings, including diffusion weighted imaging (DWI). A 78-year-old man presented with approximately a 2-mo history of constipation and without cancer history. On sigmoidoscopy, there was a luminal narrowing and thickening of rectum with mucosa being grossly normal in its appearance. On contrast-enhanced CT, marked contrast enhancement with wall thickening of rectum was noted. On pelvic MRI, rectal wall thickening showed a target sign on both T2-weighted imaging and DWI. A diffuse infiltrative lesion was suspected in the prostate gland based on low signal intensity on T2-weighted imaging and restricted diffusion. A transanal full-thickness excisional biopsy revealed metastasis from a prostate adenocarcinoma invading the submucosa to the muscularis propria consistent with metastatic RLP. We would like to emphasize the CT and MRI findings of metastatic RLP due to prostate cancer.
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Affiliation(s)
- Jin Hee You
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Chonbuk, South Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Chonbuk, South Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju 54907, Chonbuk, South Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Chonbuk, South Korea
| | - Kyu Yun Jang
- Department of Pathology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Chonbuk, South Korea
| | - Min Ro Lee
- Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju 54907, Chonbuk, South Korea
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10
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Chen HT, Xu GQ, Teng XD, Chen YP, Chen LH, Li YM. Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms. World J Gastroenterol 2014; 20:10470-10477. [PMID: 25132764 PMCID: PMC4130855 DOI: 10.3748/wjg.v20.i30.10470] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnostic accuracy of endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms (NENs) and the differential diagnosis of rectal NENs from other subepithelial lesions (SELs).
METHODS: The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens. The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology. Epithelial lesions such as cancer and adenoma were excluded from this study. One EUS expert blinded to the histological results reviewed the ultrasonic images. The size, original layer, echoic intensity and homogeneity of the lesions and the perifocal structures were investigated. The single EUS diagnosis recorded by the EUS expert was compared with the histological results.
RESULTS: All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular (n = 12), round (n = 19) or egg-shaped (n = 5) lesions with a hypoechoic (n = 7) or intermediate (n = 29) echo pattern and a distinct border. Tumors ranged in size from 2.3 to 13.7 mm, with an average size of 6.8 mm. Homogeneous echogenicity was seen in all tumors except three. Apart from three patients (stage T2 in two and stage T3 in one), the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers. In the patients with stage T1 disease, the tumors were located in the second wall layer only in seven cases, the third wall layer only in two cases, and both the second and third wall layers in 27 cases. Approximately 94.4% (34/36) of rectal NENs were diagnosed correctly by EUS, and 74.2% (23/31) of other rectal SELs were classified correctly as non-NENs. Eight cases of other SELs were misdiagnosed as NENs, including two cases of inflammatory lesions and one case each of gastrointestinal tumor, endometriosis, metastatic tumor, lymphoma, neurilemmoma, and hemangioma. The positive predictive value of EUS for rectal NENs was 80.9% (34/42), the negative predictive value was 92.0% (23/25), and the diagnostic accuracy was 85.1%.
CONCLUSION: EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity, but unfavorable specificity, making the differential diagnosis of NENs from other SELs challenging.
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11
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Venturini F, Gambi V, Di Lernia S, Vanzulli A, Bramerio M, Bencardino K, Amatu A, Cipani T, Forti E, Tarenzi E, Sartore-Bianchi A, Pugliese R, Siena S. Linitis Plastica of the Rectum As a Clinical Presentation of Metastatic Lobular Carcinoma of the Breast. J Clin Oncol 2014; 34:e54-6. [PMID: 24982453 DOI: 10.1200/jco.2013.50.6733] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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12
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McPherson VA, Ott M, Tweedie EJ, Izawa JI. Case report and review of the literature: Rectal linitis plastica secondary to the lipoid cell variant of transitional cell carcinoma of the urinary bladder. Can Urol Assoc J 2013; 6:431-4. [PMID: 23282659 DOI: 10.5489/cuaj.11239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The overall 5-year survival of patients with urothelial carcinoma of the bladder (UC) is about 78%; however, there are some rare subtypes. One of these is the lipoid cell subtype, which bears a very poor prognosis. Another rare disease entity with a poor prognosis is metastasis to the lower gastrointestinal tract in the form of secondary linitis plastica of the rectum. We describe an extremely rare and unique case of rectal linitis plastica secondary to the rare lipoid cell variant of UC.
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Affiliation(s)
- Victor A McPherson
- Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, The Schulich School of Medicine & Dentistry, Western University, London, ON
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13
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Gómez-Moreno AZ, Repiso A, Del Mar Lombera M, Guardiola A, Gómez-Rodríguez R, Carrobles JM. [Endoscopic and echoendoscopic findings in secondary linitis plastica of the rectum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:535-8. [PMID: 21652114 DOI: 10.1016/j.gastrohep.2011.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/13/2011] [Accepted: 03/17/2011] [Indexed: 01/14/2023]
Abstract
Linitis plastica of the rectum consists of intraparietal, subepithelial and circumferential tumoral infiltration of the wall of the rectum leading to a constricted rectum with mural thickening. There is often a delay between symptom onset and diagnosis because this entity mimics a large number of diseases and the findings of endoscopy and conventional biopsies are non-conclusive since the surface mucosa is not usually affected. We present the endoscopic and echoendoscopic findings of two patients with secondary linitis plastica of the rectum.
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14
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Schizas AMP, Williams AB, Meenan J. Endosonographic staging of lower intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23:663-70. [PMID: 19744631 DOI: 10.1016/j.bpg.2009.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/22/2009] [Indexed: 02/08/2023]
Abstract
The use of EUS in the assessment of rectal pathology is well established. The accurate staging of lower intestinal tumours predicts prognosis and guides the planning of individual patient treatment. Increased experience and the development of high resolution three-dimensional EUS has lead to the greater accuracy of rectal staging with EUS of rectal tumours now considered the gold standard showing T stage accuracy that ranges from 75% to 95%, with N stage accuracy ranging from 65% to 80%. The use of EUS in the staging of colonic pathology, however, is not so well established though advances in miniprobe EUS has improved the assessment of colonic tumours. EUS is also of benefit in the assessment of anal pathology though here, accurate correlation with histology has not been firmly established.
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Affiliation(s)
- Alexis M P Schizas
- Department of Colo-rectal Surgery, Guy's and St. Thomas' Hospital, London, UK
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15
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Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Wiersema MJ, Zhang L, Levy MJ. Secondary linitis plastica of the rectum: EUS features and tissue diagnosis (with video). Gastrointest Endosc 2008; 68:591-6. [PMID: 18635171 DOI: 10.1016/j.gie.2008.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/19/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Luminal metastases to the GI tract may be seen at the time of the primary diagnosis or may represent evidence of a distant recurrence. OBJECTIVES To determine the prevalence of rectal-wall metastases in patients undergoing an EUS and to describe the EUS features and yield of EUS-guided FNA (EUS-FNA) and Trucut biopsy (TCB). DESIGN A case series. SETTING A single tertiary-referral center. PATIENTS Patients undergoing lower GI (LGI) EUS from July 1, 2005, to October 31, 2007. INTERVENTION EUS-FNA and/or TCB. MAIN OUTCOME MEASUREMENTS EUS features and cytologic and/or histologic confirmation of secondary rectal linitis plastica. RESULTS Over the 28-month period, an LGI-EUS was performed in 598 patients with presumed primary rectal cancer, of whom 6 (1%) were diagnosed with rectal-wall metastases. The EUS features were that of diffuse, circumferential, hypoechoic wall-thickening that mimics that of linitis plastica, breaching the muscularis propria in all cases. EUS-FNA and/or TCB of the rectal wall or perirectal lymph node established a diagnosis in all cases. The primary cancers originated from the bladder (n = 3), breast (n = 1), stomach (n = 1), and a right forearm cutaneous melanoma (n = 1). The time interval from the initial primary cancer diagnosis to that of GI-tract rectal metastasis ranged from 0 days (simultaneous diagnoses) to 119 months (mean +/- SD 49 +/- 43 months). LIMITATIONS Although firm EUS criteria of rectal-wall metastases cannot be established based on 6 patients alone, certain features may prove useful for the diagnosis in the clinical practice. CONCLUSIONS EUS-FNA and/or TCB can confirm the diagnosis of secondary linitis plastica of the rectum.
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Affiliation(s)
- Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Department of Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Samlani-Sebbane Z, Eddafali B, Guennoun N, Krati K. [Primary linitis plastica of the rectum: a rare tumor]. ACTA ACUST UNITED AC 2008; 32:530-1. [PMID: 18372135 DOI: 10.1016/j.gcb.2007.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 12/13/2007] [Accepted: 12/14/2007] [Indexed: 12/28/2022]
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Bhutani MS. Endoscopic ultrasound in the diagnosis, staging and management of colorectal tumors. Gastroenterol Clin North Am 2008; 37:215-27, viii. [PMID: 18313547 DOI: 10.1016/j.gtc.2007.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasound (EUS) has evolved as a useful technique for imaging and intervention in the colon and rectum. This article reviews the clinical applications of EUS for imaging and intervention in colorectal cancer, with an emphasis on the most recent clinical studies.
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Affiliation(s)
- Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Unit 436, UT MD Anderson Cancer Center, Faculty Center Room 10.2028, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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Sempere L, Aparicio JR, Jover R, Casellas JA, Poveda MJ, Alonso G, Pérez-Mateo M. [Primary linitis plastica of the rectum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:68-70. [PMID: 15710085 DOI: 10.1157/13070703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Linitis plastica of the rectum is an uncommon entity that is difficult to diagnose due to the lack of mucosal lesions on endoscopy, the low diagnostic yield of biopsy and non-specific findings of barium radiology and computerized tomography. Rectal endoscopic ultrasonography has had a radical impact on the differential diagnosis of stenosing lesions of the rectum, among them linitis plastica, allowing diagnosis of this lesion even in patients with negative results of biopsy.
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Affiliation(s)
- L Sempere
- Sección de Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
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Laoutliev B, Harling H, Neergaard K, Simonsen L. Rectal metastasis from infiltrating lobular breast carcinoma: imaging with 18F-FDG PET. Eur Radiol 2004; 15:186-8. [PMID: 15449014 DOI: 10.1007/s00330-004-2394-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 04/22/2004] [Accepted: 05/24/2004] [Indexed: 02/06/2023]
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Fujii Y, Taniguchi N, Ono T, Omoto K, Itoh K, Shitoh K, Okada M, Yasuda Y, Nagai H. Primary linitis plastica carcinoma of the colon accompanied by peritoneal abscess. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:488-492. [PMID: 14595741 DOI: 10.1002/jcu.10204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We describe the case of a 75-year-old woman with linitis plastica carcinoma of the colon, accompanied by a peritoneal abscess, in which the use of transabdominal sonography enabled prompt detection and diagnosis. Sonographic examinations revealed diffuse wall thickening with blurred layer stratification in the ascending colon. The irregular outer margin of the affected area was surrounded by thickened pericolic fat. A peritoneal abscess covered by the omentum was also found. CT confirmed these findings. We extensively resected the right half of the colon. Histopathologic examination of the excised segment of the colon revealed a poorly differentiated adenocarcinoma with fibrotic infiltration. The patient was discharged 6 weeks postoperatively, and chemotherapy was begun, but she was lost to our follow-up. Although linitis plastica carcinoma of the colon is rare, it must be considered when patients have extensive colonic wall thickening with blurred layer stratification and an irregular outer margin surrounded by thickened pericolic fat. Transabdominal sonography should be considered the imaging modality of choice for the detection and diagnosis of this disease entity.
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Affiliation(s)
- Yasutomo Fujii
- Department of Clinical Laboratory Medicine, Jichi Medical School, Minami Kawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan
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Keogh CF, Brown JA, Phang PT. Linitis plastica of the rectum: utility of transrectal ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:103-106. [PMID: 11794395 DOI: 10.7863/jum.2002.21.1.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Ciaran F Keogh
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
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Nieboer P, van der Graaf WT, de Knegt RJ, van Dullemen HM. Rectal syndrome as first presentation of metastatic breast cancer. Am J Gastroenterol 2000; 95:2138-9. [PMID: 10950087 DOI: 10.1111/j.1572-0241.2000.02217.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hasebe T, Morihiro M, Sasaki S, Shimoda T, Sugitoh M, Moriya Y, Ono M, Arai T, Ochiai A. Tumor thickness is a histopathologic predictive parameter of tumor metastasis and prognosis in patients with Dukes stage C ulcerative-type colorectal carcinoma. A two-hospital-based study. Cancer 2000; 89:35-45. [PMID: 10896998 DOI: 10.1002/1097-0142(20000701)89:1<35::aid-cncr6>3.0.co;2-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Metastasis to the liver or lymph nodes is an important prognostic factor in patients with colorectal carcinoma. The purpose of the current study was to estimate the power of tumor thickness in predicting metachronous liver metastasis (MLM), lymph node metastasis (LNM), or overall survival (OS) in patients at two hospitals (the National Cancer Center Hospital [NCCH] and the National Cancer Center Hospital East [NCCHE]) to confirm the reproducibility of the study. METHODS The subjects of this study were 74 and 186 consecutive patients with ulcerative-type colorectal carcinoma treated at the NCCH and NCCHE, respectively. Tumor thickness was measured in three areas: 1) the marginal elevated area (MEA), 2) the central depressed area (CDA), and 3) the most thickened area (MTA). Studies were performed with well known histologic parameters to compare the predictive power of tumor thickness on MLM, LNM, and OS using the Cox proportional hazards regression model or analysis of variance. RESULTS A significant correlation between tumor thickness and MLM was observed only in the CDA in the NCCH patients (P = 0.005). The authors applied a tumor thickness cutoff value in the CDA of 10 mm (</= 10 mm and > 10 mm) for further study. Multivariate analyses demonstrated that a tumor CDA thickness > 10 mm was associated significantly with MLM, multiple LNMs, and OS in NCCH patients with Dukes Stage C disease (P = 0.002, P = 0.023, and P = 0.002, respectively). A significant predictive power for tumor CDA thickness for MLM, multiple LNMs, and OS was confirmed by multivariate analysis in NCCHE patients with Dukes Stage C disease (P = 0.008, P = 0.021, and P = 0.010, respectively). CONCLUSIONS The CDA thickness of the tumor was found to be a useful predictive parameter for MLM, multiple LNMs, and OS in patients with Dukes Stage C ulcerative-type colorectal carcinoma who were being treated in two independent hospitals.
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Affiliation(s)
- T Hasebe
- Pathology Division, National Cancer Center Research Institute East, Chiba, Japan
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Bhutani MS. EUS and EUS-guided fine-needle aspiration for the diagnosis of rectal linitis plastica secondary to prostate carcinoma. Gastrointest Endosc 1999; 50:117-9. [PMID: 10385739 DOI: 10.1016/s0016-5107(99)70361-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M S Bhutani
- University of Florida and Veterans Affairs Medical Center, Gainesville, Florida, USA
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