Diagnosis of Linitis Plastica-Type Gastric Adenocarcinoma by Endoscopic Ultrasound-Guided Fine Needle Aspiration : A Case Report

The diagnosis of linitis plastica-type adenocarcinomas of the stomach has traditionally been made by brush cytology and mucosal biopsy. These techniques may yield false negative results due to the often submucosal location of these lesions. A 46-year-old woman presented witb epigaseric abdominal pain and loss of abbetite. Computed tomography of her abdomen revealed diffuse thickening of a portion of the gastric wall. Subsequent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the stomach yielded abundant single, discohesive malignant cells suspicious for lymphoma vs. poorly differentiated carcinoma. Special stains and immunohistochemical stains confirmed the diagnosis of poorly differentiated adenocarcinoma ofsignet ring cell type. As many linitisplastica-type adenocarcinomas are submucosal lesions, mucosal sampling by biopsy may yield nondiagnostic material in up to one third of cases. With its ability to sample deep submucosal lesions, EUS-FNA is an appropriate technique for establishing this diagnosis and guiding patient treatment.