Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11607
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
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 syn
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.
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.