Linitis plastica pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
On | On gross pathology, a thick, rigid, and leather bottle-like stomach wall is a characteristic finding 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 name=mk>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== | ||
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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, a thick, rigid, and leather bottle-like stomach wall is a characteristic finding 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
- Linitis plastica is a morphological variant of diffuse (or infiltrating) gastric adenocarcinoma (stomach cancer).[1]
- Adenocarcinoma is the most common type of gastric cancer accounting to almost 90% of the same, of which about 10% constitute linitis plastica.[3]
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][4]
- Hereditary form of diffuse gastric adenocarcinoma is transmitted in an autosomal dominant fashion, with a 70% disease penetrance.[2][4]
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]
-
![Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.[5]](/images/7/76/Linitis_plastica1.jpg)
Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.[5]
![Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.[5]](/index.php/File:Linitis_plastica1.jpg)
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.[6][7]
- 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.[6]
- Although the lower mucosal and submucosal layers are mostly involved, the muscular and subserosal layers may also be infiltrated with the neoplastic cells.[8]
-
![A signet ring cell carcinoma of the stomach. Signet ring cells are seen in the lower half of the image. Gastric epithelium is seen in the upper half of the image. H&E stain.[9]](/images/3/39/Gastric_signet_ring_cell_carcinoma.jpg)
A signet ring cell carcinoma of the stomach. Signet ring cells are seen in the lower half of the image. Gastric epithelium is seen in the upper half of the image. H&E stain.[9]
-
![Gastric signet ring cell carcinoma. H&E stain.[10]](/images/4/44/Gastric_signet_ring_cell_carcinomahistopatholgy.jpg)
Gastric signet ring cell carcinoma. H&E stain.[10]
![A signet ring cell carcinoma of the stomach. Signet ring cells are seen in the lower half of the image. Gastric epithelium is seen in the upper half of the image. H&E stain.[9]](/index.php/File:Gastric_signet_ring_cell_carcinoma.jpg)
![Gastric signet ring cell carcinoma. H&E stain.[10]](/index.php/File:Gastric_signet_ring_cell_carcinomahistopatholgy.jpg)
References
- ↑ 1.0 1.1 1.2 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.
- ↑ Malignant tumours of the stomach. Canadian cancer society. http://www.cancer.ca/en/cancer-information/cancer-type/stomach/stomach-cancer/malignant-tumours/?region=nb Accessed on November 12, 2015.
- ↑ 4.0 4.1 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.
- ↑ Linitis Plastica. Wikimedia. https://en.wikipedia.org/wiki/Linitis_plastica#/media/File:Linitis_plastica_2.jpg Accessed on December 13, 2015
- ↑ 6.0 6.1 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
|month=ignored (help) - ↑ Linitis Plastica. Wikimedia. https://en.wikipedia.org/wiki/Signet_ring_cell_carcinoma#/media/File:Signet_ring_cell_carcinoma_-_very_high_mag.jpg Accessed on December 13, 2015
- ↑ Linitis Plastica. Wikimedia.https://en.wikipedia.org/wiki/Signet_ring_cell_carcinoma#/media/File:Gastric_signet_ring_cell_carcinoma_histopatholgy_%281%29.jpg Accessed on December 13, 2015.
