Linitis plastica (leather bottle stomach) is a clinical-radiological entity characterized by diffuse concentric thickening and rigidity of the gastric wall by infiltrative tumor. It most commonly presents as an advanced form of diffuse-type (Lauren) gastric adenocarcinoma (especially signet ring cell carcinoma); however, breast, pancreatic, or colon metastases can also create a similar picture. The gastric wall thickens, hardens, and loses its flexibility due to desmoplastic reaction. On CT, diffuse concentric wall thickening, decreased distensibility, and obliteration of perigastric fat planes are characteristic.
Age Range
30-70
Peak Age
50
Gender
Female predominant
Prevalence
Uncommon
Linitis plastica develops through submucosal and intramural spread of diffuse-type gastric adenocarcinoma (especially signet ring cell carcinoma). Tumor cells infiltrate all layers of the gastric wall spreading beneath the mucosa and create intense desmoplastic (fibrotic) reaction. CDH1 gene mutation with E-cadherin loss leads to disruption of cell-cell adhesion and infiltrative growth pattern. Desmoplastic reaction hardens the gastric wall through fibroblast activation and collagen accumulation; this reflects as progressive delayed enhancement on imaging because fibrotic tissue retains contrast late and washes out slowly. Loss of gastric flexibility and lumen narrowing cause early satiety and weight loss in patients. Peritoneal spread (carcinomatosis) and Krukenberg tumor (ovarian metastasis) are frequent complications.
The pathognomonic finding of linitis plastica is diffuse concentric thickening of the gastric wall with loss of flexibility and luminal narrowing. On CT, the stomach cannot adequately fill with air/water and assumes a small, rigid, tubular appearance. On barium study, loss of peristalsis and effacement of rugal folds complete the 'leather bottle' appearance. Progressive delayed enhancement confirms desmoplastic reaction.
Report Sentence
In the arterial phase, diffuse concentric [X] mm gastric wall thickening and luminal narrowing are noted, consistent with linitis plastica.
Report Sentence
In the portal venous phase, diffuse gastric wall thickening, perigastric fat plane obliteration, and omental nodular thickening are noted, consistent with linitis plastica and peritoneal carcinomatosis.
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Progressive enhancement in gastric wall thickening is noted in the delayed phase, consistent with desmoplastic reaction and linitis plastica.
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On MRI, diffuse gastric wall thickening with diffusion restriction on DWI and progressive enhancement on dynamic sequences is noted, consistent with linitis plastica.
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On PET-CT, mild/moderate FDG uptake (SUVmax: [X]) is noted in diffuse gastric wall thickening, consistent with limited FDG avidity in the setting of diffuse-type adenocarcinoma/linitis plastica.
Report Sentence
On barium study, diffuse luminal narrowing, effacement of rugal folds, and rigidity of the stomach are noted, consistent with linitis plastica ('leather bottle' appearance).
Criteria
The most common form, representing the advanced stage of diffuse-type (Lauren) gastric adenocarcinoma, especially signet ring cell carcinoma. CDH1 mutation is found in hereditary forms. Generally more common in younger patients (<50 years) and females. Prognosis is poor; 5-year survival is <15%. Peritoneal carcinomatosis and Krukenberg tumor are frequent complications.
Distinct Features
Criteria
Breast carcinoma (especially lobular type), pancreatic cancer, colon cancer, or bladder cancer metastases can create a linitis plastica picture through diffuse infiltration of the gastric wall. Known primary malignancy history is critical for diagnosis. E-cadherin loss of breast lobular carcinoma creates a similar infiltrative pattern to gastric diffuse-type adenocarcinoma.
Distinct Features
Criteria
An autosomal dominant syndrome characterized by CDH1 germline mutation. Lifetime gastric cancer risk is 70-80%. Multicentric diffuse adenocarcinoma develops at early age (<40) and progresses to linitis plastica. Prophylactic total gastrectomy is recommended. Risk of lobular breast carcinoma is also increased in females. Genetic counseling and family screening are mandatory.
Distinct Features
Distinguishing Feature
Distinguishing Feature
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Urgency
Management
Biopsy
Not NeededFollow-up
Linitis plastica has poor prognosis (5-year survival <5%). Usually diagnosed at advanced stage. Peritoneal carcinomatosis is common. Total gastrectomy + chemotherapy is standard but not curative.