Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report

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.

Revolutionizing gastric linitis plastica diagnosis: the crucial role of EUS-FNA in a sequential diagnostic approach

“…Recent reports have highlighted the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for GLP in the event of a negative endoscopic biopsy 9 . In instances where a stomach mucosal biopsy fails to yield a definitive diagnosis in individuals with gastrointestinal stromal tumors (GLP), an EUS-FNB was helpful for the histological diagnosis 10 . Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy has developed into a preeminent technique for verifying the diagnosis of the pre-therapeutic assessment in patients with suspected upper gastrointestinal tract submucosal malignancies 11 .…”