Gastric linitis is a very special form of stomach cancer, fortunately relatively rare. Difficult to diagnose and poor prognosis, it requires a total gastrectomy.

Definition

Gastric linitis, sometimes called plastic linitis, is a very specific malignant tumor of the stomach. It is a form of diffuse and infiltrating gastric adenocarcinoma with independent cells (so-called kitten ring cells). This proliferation causes thickening and stiffness of the stomach wall, characteristic of gastric linitis. Linitis can be localized (less than 2/3 of the stomach) or diffuse. The antrum and the pylorus are the parts of the stomach that are usually affected.

Gastric linitis was first described by William Brinton in 1854 as Linitis plastic. It was considered then as a fibrosing inflammatory disease of the gastric wall, hence the term “linitis” indicating inflammation. Today, it has different names in the scientific literature: gastric linitis, independent cell adenocarcinoma, diffuse-type adenocarcinoma, poorly differentiated adenocarcinoma, Brinton’s disease, etc.

Causes

The pathophysiology of gastric linitis remains unknown to this day. Unlike stomach cancer, it doesn’t seem to involve the germ Helicobacter pylori.

However, there are rare familial forms of gastric linitis. A mutation in the anti-oncogene CDH1 with loss of function of the E-Cadherin protein has been demonstrated in certain family series. A mutation in the PSCA (prostate stem cell antigen) gene has been demonstrated in some Japanese patients.

Diagnostic

The diagnosis of gastric linitis is often difficult because the lining of the stomach is not abnormal, and biopsies usually only look at the lining. The diagnosis of the disease is therefore based on various examinations:

• echendoscopy, which shows a thickening of the gastric wall at the expense of the submucosa, with the presence of large folds;
• anatomopathological analysis of various submucosal biopsies performed by endoscopy shows kitten ring cells in a fibrous stroma;
• ultrasound;
• the scanner.

These examinations make it possible to rule out other diseases: usual gastric cancers (adenocarcinoma and lymphoma), but also certain benign diseases characterized by thickening of the stomach wall (Ménétrier’s disease, lymphoid hyperplasia and amyloidosis).

After the diagnosis of gastric linitis, an extension assessment is performed. Unlike other gastric cancers, peritoneal and lymphatic extension is indeed common with gastric linitis.

Persons concerned

Much less common than adenocarcinoma of the stomach, gastric linitis accounts for only 5 to 10% of stomach cancers. Unlike classic stomach cancer, which mainly affects men over 65, gastric linitis appears at a younger age and has a slight female predilection. It mainly affected people of Asian descent, but it is becoming more and more common in Europe.

The symptoms of gastric linitis are not very representative:

• epigastric pain;
• nausea and vomiting;
• a deterioration of the general condition;
• weight loss;
• dysphagia.

Total gastrectomy, that is to say the removal of the entire stomach, remains the standard treatment in the absence of metastasis.

Chemotherapy is ineffective in gastric linitis. It will only be prescribed in the event of metastasis, in order to prolong survival and improve quality of life.