Gastric Cancer Retrospectively Investigated for 9 Years and 6 Months: A Case of Linitis Plastica

Abstract

This report presents a rare case of a patient with gastric cancer whose clinical course with the development of tumor from early cancer type IIc to advanced cancer of linitis plastica was observed for 9.5 years. The cancer remained in early stage for 3 years and 8 months after the patient’s first endoscopy. At 5 years and 10 months after initial endoscopy, the lesion progressed to advanced cancer, and after 6 years and 7 months sclerotic changes in the gastric wall were detected at the lesion site. After 9 years, advanced gastric cancer of linitis plastica was present throughout the stomach. The initial stage of linitis plastica is considered to be early gastric cancer type IIc with histologically undifferentiated cancer cells. It is widely accepted that a period of 6–8 years is required for this type of cancer to develop from carcinogenesis to completion of lesions. The present case is valuable in that development from early gastric cancer type IIc to linitis plastica during approximately 10 years of follow up was clinically observed, and will contribute to knowledge of the natural history of gastric cancer.

The significance of a nineteenth century definition in the era of genomics: linitis plastica

“…Clinicopathological characteristics of Borrmann IV tumors include an association with younger age and female gender, detection in an advanced stage, high incidence in the middle third or diffusely involving the entire stomach, predominance of Lauren diffuse-type and undifferentiated histology, deeper invasion of the gastric wall, a high rate of peritoneal and lymphatic involvement, low rate of liver metastases, and a high rate of recurrence after curative-intent surgery [ 20 – 22 ]. The natural history of Borrmann IV tumors has been investigated, and reports state that the precursor of a Borrmann IV tumor is probably a Borrmann type 0-IIc lesion (a superficially depressed early GC) and not a Borrmann III lesion [ 11 , 23 – 25 ]. Borrmann type III tumors, instead, represent 59–68% [ 21 , 22 , 26 ] of GCs.…”

“…This effect may be due to the relatively normal state of the mucosa in comparison to the involvement and contraction of the submucosal and muscular layers [ 2 , 11 ]. The pattern of waffle-like LP has been extensively described in several Japanese studies, and in case reports of patients refusing surgery and subsequently being followed for years [ 11 , 23 – 25 ]. The first lesion generally originates from the proximal or middle stomach, near the great curve, as a type IIc (flat depressed) early GC.…”

“…This condition may remain stable for 2–5 years ( slow-phase ), until the lesion progresses to advanced GC and ulcerates reaching the submucosal layer. At this point, the ulcerative lesion can persist or heal, while the submucosal involvement, once a scirrhous reaction is initiated, enters a fast-phase , involving the entire stomach (LP) in about 1 year [ 23 – 25 ].

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Linitis Plastica of The Stomach: A Review

“…The most commonly reported cases of secondary LP are those associated with metastatic invasive lobular carcinoma of the breast, which presents with identical radiologic and nearly identical histologic characteristics to primary linitis plastica 29 . Notably, lobular breast carcinoma is also a feature of hereditary diffuse GC 30 , and it often contains scattered SRCs 29 .…”