Secondary linitis plastica of the rectum: EUS features and tissue diagnosis (with video)

Ferga C. Gleeson, Jonathan E. Clain, Elizabeth Rajan, Mark D. Topazian, Kenneth K. Wang, Maurits J. Wiersema, Lizhi Zhang, Michael J. Levy

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Luminal metastases to the GI tract may be seen at the time of the primary diagnosis or may represent evidence of a distant recurrence. Objectives: To determine the prevalence of rectal-wall metastases in patients undergoing an EUS and to describe the EUS features and yield of EUS-guided FNA (EUS-FNA) and Trucut biopsy (TCB). Design: A case series. Setting: A single tertiary-referral center. Patients: Patients undergoing lower GI (LGI) EUS from July 1, 2005, to October 31, 2007. Intervention: EUS-FNA and/or TCB. Main Outcome Measurements: EUS features and cytologic and/or histologic confirmation of secondary rectal linitis plastica. Results: Over the 28-month period, an LGI-EUS was performed in 598 patients with presumed primary rectal cancer, of whom 6 (1%) were diagnosed with rectal-wall metastases. The EUS features were that of diffuse, circumferential, hypoechoic wall-thickening that mimics that of linitis plastica, breaching the muscularis propria in all cases. EUS-FNA and/or TCB of the rectal wall or perirectal lymph node established a diagnosis in all cases. The primary cancers originated from the bladder (n = 3), breast (n = 1), stomach (n = 1), and a right forearm cutaneous melanoma (n = 1). The time interval from the initial primary cancer diagnosis to that of GI-tract rectal metastasis ranged from 0 days (simultaneous diagnoses) to 119 months (mean ± SD 49 ± 43 months). Limitations: Although firm EUS criteria of rectal-wall metastases cannot be established based on 6 patients alone, certain features may prove useful for the diagnosis in the clinical practice. Conclusions: EUS-FNA and/or TCB can confirm the diagnosis of secondary linitis plastica of the rectum.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalGastrointestinal endoscopy
Volume68
Issue number3
DOIs
StatePublished - Sep 1 2008

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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