Sato R, Matsumoto K, Kanzaki H, Matsumi A, Miyamoto K, Morimoto K, Terasawa H, Fujii Y, Yamazaki T, Uchida D, Tsutsumi K, Horiguchi S, Kato H. Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report. World J Clin Cases 2022; 10(31): 11607-11616 [PMID: 36387831 DOI: 10.12998/wjcc.v10.i31.11607]
Corresponding Author of This Article
Kazuyuki Matsumoto, MD, PhD, Assistant Professor, Doctor, Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. matsumoto.k@okayama-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Sato R and Matsumoto K organized the report and wrote the paper; Kanzaki H, Matsumi A, Miyamoto K, Morimoto K, and Terasawa H took care of the patient; Fujii Y, Yamazaki T, Uchida D, Tsutsumi K, and Horigushi S contributed to data analysis and gave us pathological ideas; Kato H helped by supervising and approving the final manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kazuyuki Matsumoto, MD, PhD, Assistant Professor, Doctor, Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. matsumoto.k@okayama-u.ac.jp
Received: July 19, 2022 Peer-review started: July 19, 2022 First decision: August 19, 2022 Revised: August 30, 2022 Accepted: September 27, 2022 Article in press: September 27, 2022 Published online: November 6, 2022 Processing time: 99 Days and 23.5 Hours
Abstract
BACKGROUND
Gastric linitis plastica (GLP) is a subset of gastric cancer with a poor prognosis. It is difficult to obtain a definitive diagnosis by endoscopic mucosal biopsies, and the usefulness of an endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for GLP has been recently reported. Meanwhile, autoimmune diseases are occasionally known to coexist with malignant tumors as paraneoplastic syndrome. We herein report the usefulness of an EUS-FNB for detecting GLP and the possibility of paraneoplastic syndrome coexisting with GLP.
CASE SUMMARY
An 81-year-old man was admitted to our hospital for a 1-mo history of epigastric pain that increased after eating. His laboratory data revealed high levels of serum carbohydrate antigen 19-9 and immunoglobulin-G4. Endoscopic examinations showed giant gastric folds and reddish mucosa; however, no epithelial changes were observed. The gastric lumen was not distensible by air inflation, suggesting GLP. Computed tomography showed the thickened gastric wall, the diffuse enlargement of the pancreas, and the peripancreatic rim, which suggested autoimmune pancreatitis (AIP) coexisting with GLP. Because the pathological findings of the endoscopic biopsy showed no malignancy, he underwent an EUS-FNB and was diagnosed with GLP. He received chemotherapy for unresectable gastric cancer due to peritoneal metastasis, after which both the gastric wall thickening and diffuse enlargement of the pancreas were improved.
CONCLUSION
An EUS-FNB for GLP with a negative endoscopic biopsy is useful, and AIP may develop as a paraneoplastic syndrome.
Core Tip: Gastric linitis plastica (GLP) is a form of gastric cancer that is difficult to diagnose by an endoscopic biopsy. An ultrasonography-guided fine-needle biopsy is useful for diagnosing GLP with negative endoscopic biopsy findings. Meanwhile, autoimmune pancreatitis (AIP) is an immunoglobulin-G4 related disease (IgG4-RD) that occasionally coexists with gastric cancer. Some cases of IgG4-RD have been reported to be improved by the treatment of malignant tumors, suggesting that IgG4-RD may develop as a paraneoplastic syndrome. From the clinical course and image findings, we experienced a suspected case of AIP developed as paraneoplastic syndrome coexisting with GLP.
