Linitis plastica pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
On gross pathology, thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the tumor | On [[gross pathology]], thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the [[tumor cell]]s are characteristic findings of linitis plastica.<ref name=lp>Linitis plastica. Wikipedia. https://en.wikipedia.org/wiki/Linitis_plastica Accessed on November 18, 2015.</ref> On microscopic histopathological analysis, atypical [[signet ring cell]]s diffusely infiltrating the stomach wall, [[submucosal]] [[fibrosis]] and thickening, with minimal [[mucosa]]l involvement are characteristic findings of linitis plastica. Development of linitis plastica is the result of genetic mutation in the ''CDH1'' ([[E-cadherin]]) gene, that is responsible for intercellular adhesions.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on December 8, 2015.</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
===Genetics=== | ===Genetics=== | ||
*Germline mutations in the ''CDH1'' ([[E-cadherin]]) gene, resulting in altered intercellular adhesions, may be involved in the pathogenesis of diffuse gastric adenocarcinoma.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on November 19, 2015.</ref><ref name="WolfGeigl2010">{{cite journal|last1=Wolf|first1=E.-M.|last2=Geigl|first2=J.B.|last3=Svrcek|first3=M.|last4=Vieth|first4=M.|last5=Langner|first5=C.|title=Hereditäres Magenkarzinom|journal=Der Pathologe|volume=31|issue=6|year=2010|pages=423–429|issn=0172-8113|doi=10.1007/s00292-010-1353-7}}</ref> | *[[Germline]] mutations in the ''CDH1'' ([[E-cadherin]]) gene, resulting in altered intercellular adhesions, may be involved in the pathogenesis of diffuse gastric adenocarcinoma.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on November 19, 2015.</ref><ref name="WolfGeigl2010">{{cite journal|last1=Wolf|first1=E.-M.|last2=Geigl|first2=J.B.|last3=Svrcek|first3=M.|last4=Vieth|first4=M.|last5=Langner|first5=C.|title=Hereditäres Magenkarzinom|journal=Der Pathologe|volume=31|issue=6|year=2010|pages=423–429|issn=0172-8113|doi=10.1007/s00292-010-1353-7}}</ref> | ||
*Hereditary form of diffuse gastric adenocarcinoma is transmitted in an autosomal dominant fashion, with a 70% disease penetrance.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on November 19, 2015.</ref><ref name="WolfGeigl2010">{{cite journal|last1=Wolf|first1=E.-M.|last2=Geigl|first2=J.B.|last3=Svrcek|first3=M.|last4=Vieth|first4=M.|last5=Langner|first5=C.|title=Hereditäres Magenkarzinom|journal=Der Pathologe|volume=31|issue=6|year=2010|pages=423–429|issn=0172-8113|doi=10.1007/s00292-010-1353-7}}</ref> | *Hereditary form of diffuse gastric adenocarcinoma is transmitted in an [[autosomal dominant]] fashion, with a 70% disease [[penetrance]].<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on November 19, 2015.</ref><ref name="WolfGeigl2010">{{cite journal|last1=Wolf|first1=E.-M.|last2=Geigl|first2=J.B.|last3=Svrcek|first3=M.|last4=Vieth|first4=M.|last5=Langner|first5=C.|title=Hereditäres Magenkarzinom|journal=Der Pathologe|volume=31|issue=6|year=2010|pages=423–429|issn=0172-8113|doi=10.1007/s00292-010-1353-7}}</ref> | ||
===Gross pathology=== | ===Gross pathology=== | ||
*On gross pathology, thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the tumor cells are characteristic findings of linitis plastica.<ref name=lp>Linitis plastica. Wikipedia. https://en.wikipedia.org/wiki/Linitis_plastica Accessed on November 18, 2015.</ref> | *On gross pathology, thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the tumor cells are characteristic findings of linitis plastica.<ref name=lp>Linitis plastica. Wikipedia. https://en.wikipedia.org/wiki/Linitis_plastica Accessed on November 18, 2015.</ref> | ||
*As a result of the tumor cell infiltration and fibrosis, there is diffuse thickening and rigidity of the gastric wall, making the process of digestion difficult. | *As a result of the tumor cell infiltration and [[fibrosis]], there is diffuse thickening and rigidity of the gastric wall, making the process of digestion difficult. | ||
*Metastasis to the [[peritoneum]], [[lymph node]]s and/or other organs usually occurs by the time linitis plastica is diagnosed. Linitis plastica may also occur secondary to metastasis from other primary cancers, particularly infiltrating lobular carcinoma of breast.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on December 7, 2015.</ref> | *[[Metastasis]] to the [[peritoneum]], [[lymph node]]s and/or other organs usually occurs by the time linitis plastica is diagnosed. Linitis plastica may also occur secondary to metastasis from other primary cancers, particularly infiltrating lobular carcinoma of breast.<ref name=gl>Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on December 7, 2015.</ref> | ||
===Microscopic pathology=== | ===Microscopic pathology=== | ||
*In diffuse type adenocarcinoma (mucinous, colloid), tumour cells are discohesive and secrete mucus, which is delivered in the interstitium, producing large pools of mucus or colloid (optically "empty" spaces). If the mucus remains inside the tumour cell, it pushes the nucleus to the periphery, leaving a "signet-ring cell" appearance. | *In diffuse type adenocarcinoma (mucinous, [[colloid]]), tumour cells are discohesive and secrete mucus, which is delivered in the [[interstitium]], producing large pools of mucus or colloid (optically "empty" spaces). If the mucus remains inside the tumour cell, it pushes the nucleus to the periphery, leaving a "signet-ring cell" appearance. | ||
*On microscopic histopathological analysis, poorly differentiated, atypical [[signet ring cell]]s diffusely infiltrating the stomach wall, submucosal fibrosis and thickening, with minimal [[mucosa]]l involvement are characteristic findings of linitis plastica.<ref name="SchauerPeiper2011">{{cite journal|last1=Schauer|first1=M|last2=Peiper|first2=M|last3=Theisen|first3=J|last4=Knoefel|first4=W|title=Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment|journal=European Journal of Medical Research|volume=16|issue=1|year=2011|pages=29|issn=2047-783X|doi=10.1186/2047-783X-16-1-29}}</ref><ref>Stomach cancer. Wikipedia. https://en.wikipedia.org/wiki/Stomach_cancer Accessed on November 19, 2015.</ref> | *On microscopic histopathological analysis, poorly differentiated, atypical [[signet ring cell]]s diffusely infiltrating the stomach wall, submucosal fibrosis and thickening, with minimal [[mucosa]]l involvement are characteristic findings of linitis plastica.<ref name="SchauerPeiper2011">{{cite journal|last1=Schauer|first1=M|last2=Peiper|first2=M|last3=Theisen|first3=J|last4=Knoefel|first4=W|title=Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment|journal=European Journal of Medical Research|volume=16|issue=1|year=2011|pages=29|issn=2047-783X|doi=10.1186/2047-783X-16-1-29}}</ref><ref>Stomach cancer. Wikipedia. https://en.wikipedia.org/wiki/Stomach_cancer Accessed on November 19, 2015.</ref> | ||
*Superficial mucosal layers are usually spared and rarely show superficial | *Superficial mucosal layers are usually spared and rarely show superficial ulcers on endoscopy, that has a wide differential diagnosis, making the diagnosis even more difficult. The biopsies are falsely negative, as the disease remains mostly in the [[submucosa]] and muscularis propria.<ref name="SchauerPeiper2011">{{cite journal|last1=Schauer|first1=M|last2=Peiper|first2=M|last3=Theisen|first3=J|last4=Knoefel|first4=W|title=Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment|journal=European Journal of Medical Research|volume=16|issue=1|year=2011|pages=29|issn=2047-783X|doi=10.1186/2047-783X-16-1-29}}</ref> | ||
*Although the lower | *Although the lower [[mucosa]]l and [[submucosa]]l layers are mostly involved, the muscular and subserosal layers may also be infiltrated with the neoplastic cells.<ref>{{Cite journal | ||
| author = [[Bing Hu]], [[Nassim El Hajj]], [[Scott Sittler]], [[Nancy Lammert]], [[Robert Barnes]] & [[Aurelia Meloni-Ehrig]] | | author = [[Bing Hu]], [[Nassim El Hajj]], [[Scott Sittler]], [[Nancy Lammert]], [[Robert Barnes]] & [[Aurelia Meloni-Ehrig]] | ||
| title = Gastric cancer: Classification, histology and application of molecular pathology | | title = Gastric cancer: Classification, histology and application of molecular pathology | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 01:58, 14 December 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]
Overview
On gross pathology, thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the tumor cells are characteristic findings of linitis plastica.[1] On microscopic histopathological analysis, atypical signet ring cells diffusely infiltrating the stomach wall, submucosal fibrosis and thickening, with minimal mucosal involvement are characteristic findings of linitis plastica. Development of linitis plastica is the result of genetic mutation in the CDH1 (E-cadherin) gene, that is responsible for intercellular adhesions.[2]
Pathophysiology
Genetics
- Germline mutations in the CDH1 (E-cadherin) gene, resulting in altered intercellular adhesions, may be involved in the pathogenesis of diffuse gastric adenocarcinoma.[2][3]
- Hereditary form of diffuse gastric adenocarcinoma is transmitted in an autosomal dominant fashion, with a 70% disease penetrance.[2][3]
Gross pathology
- On gross pathology, thick, rigid, leather bottle-like stomach from diffuse infiltration of the stomach wall by the tumor cells are characteristic findings of linitis plastica.[1]
- As a result of the tumor cell infiltration and fibrosis, there is diffuse thickening and rigidity of the gastric wall, making the process of digestion difficult.
- Metastasis to the peritoneum, lymph nodes and/or other organs usually occurs by the time linitis plastica is diagnosed. Linitis plastica may also occur secondary to metastasis from other primary cancers, particularly infiltrating lobular carcinoma of breast.[2]
Microscopic pathology
- In diffuse type adenocarcinoma (mucinous, colloid), tumour cells are discohesive and secrete mucus, which is delivered in the interstitium, producing large pools of mucus or colloid (optically "empty" spaces). If the mucus remains inside the tumour cell, it pushes the nucleus to the periphery, leaving a "signet-ring cell" appearance.
- On microscopic histopathological analysis, poorly differentiated, atypical signet ring cells diffusely infiltrating the stomach wall, submucosal fibrosis and thickening, with minimal mucosal involvement are characteristic findings of linitis plastica.[4][5]
- Superficial mucosal layers are usually spared and rarely show superficial ulcers on endoscopy, that has a wide differential diagnosis, making the diagnosis even more difficult. The biopsies are falsely negative, as the disease remains mostly in the submucosa and muscularis propria.[4]
- Although the lower mucosal and submucosal layers are mostly involved, the muscular and subserosal layers may also be infiltrated with the neoplastic cells.[6]
References
- ↑ 1.0 1.1 Linitis plastica. Wikipedia. https://en.wikipedia.org/wiki/Linitis_plastica Accessed on November 18, 2015.
- ↑ 2.0 2.1 2.2 2.3 Gastric linitis plastica. Orphanet. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=36273 Accessed on December 8, 2015.
- ↑ 3.0 3.1 Wolf, E.-M.; Geigl, J.B.; Svrcek, M.; Vieth, M.; Langner, C. (2010). "Hereditäres Magenkarzinom". Der Pathologe. 31 (6): 423–429. doi:10.1007/s00292-010-1353-7. ISSN 0172-8113.
- ↑ 4.0 4.1 Schauer, M; Peiper, M; Theisen, J; Knoefel, W (2011). "Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment". European Journal of Medical Research. 16 (1): 29. doi:10.1186/2047-783X-16-1-29. ISSN 2047-783X.
- ↑ Stomach cancer. Wikipedia. https://en.wikipedia.org/wiki/Stomach_cancer Accessed on November 19, 2015.
- ↑ Bing Hu, Nassim El Hajj, Scott Sittler, Nancy Lammert, Robert Barnes & Aurelia Meloni-Ehrig (2012). "Gastric cancer: Classification, histology and application of molecular pathology". Journal of gastrointestinal oncology. 3 (3): 251–261. doi:10.3978/j.issn.2078-6891.2012.021. PMID 22943016. Unknown parameter
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