A case report of gastric linitis plastica diagnosed by endoscopic ultrasound-guided fine needle aspiration

Abstract

Rationale:There is currently no consensus on the ideal method for obtaining deep tissue biopsy material of advanced gastric LP. EUS-FNA has potential as a useful diagnostic method. Thus, we report the case of a 46-year-old male with advanced gastric linitis plastica (LP) who was diagnosed using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA).Patient concerns:The patient underwent esophagogastroduodenoscopy (EGD) because of epigastric pain at a local clinic. The gastric fold swelling was pointed out by the EGD and despite the suspected advanced gastric LP, biopsy indicated Group 1. Repeat biopsy did not suggest malignancy. The patient was referred to our institution.Diagnoses:Endoscopic ultrasound indicated gastric wall thickening mainly in the greater curvature of the gastric corpus. Low-level echoes were detected throughout the entire gastric wall, and gastric wall layers had been disappeared. EUS-FNA of the gastric wall indicated signet ring cell carcinoma.Interventions:As a result of EUS - FNA, it became a policy to administer chemotherapy. In accordance with the patient's wishes, he was referred to another institution for chemotherapy.Outcomes:Normal biopsy did not give a definitive pathological diagnosis, and final diagnosis of LP was obtained with EUS-FNA.Lessons:We expect that EUS-FNA can be utilized as a relatively non-invasive, highly sensitive, and specific pathological diagnostic procedure for advanced gastric LP. EUS-FNA should be considered as one way to obtain a deep tissue biopsy of advanced gastric LP.

Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy

“…Therefore, in such cases, it is desirable to initiate chemotherapy immediately after the confirmation of histological diagnosis. In addition, diseases that present with a diffuse or segmental thickened gastric wall that require differentiation from GLP include malignant lymphoma and benign etiologies such as gastritis secondary to Helicobacter pylori infection, Ménétrier disease, gastric amyloidosis, gastric sarcoidosis, gastroduodenal Crohn disease, and gastric immunoglobulin G4-related disease [23,36,37], all of which do not require surgery. Contrary to that proposed by Song et al [15], core tissue sampling has recently become feasible due to the development of FNB needles, and EUS-FNA biopsy is expected to be adopted as a minimally invasive diagnostic modality.…”

“…Theoretically, EUS-FNA may be advantageous for the diagnosis of GLP infiltrating the submucosa, since tissue samples from deep lesions including those in the submucosa can be acquired with this approach. However, limited data are available regarding the diagnosis of GLP by EUS-FNA biopsy [21][22][23]. The present study aimed to investigate the value of EUS for GLP diagnosis by evaluating outcomes of EUS-FNA biopsy in patients with GLP and negative endoscopic biopsy findings.…”

“…Since missed diagnosis adversely affects the treatment and prognosis of patients, the development of diagnostic modalities other than the conventional endoscopic biopsy is warranted. To date, several alternative diagnostic techniques, such as percutaneous fine-needle aspiration (FNA) biopsy [16,17], endoscopic mucosal resection (EMR) [18,19], endoscopic submucosal dissection (ESD) [20], and endoscopic ultrasound (EUS)-guided FNA biopsy [21][22][23] have been described in case reports and a small number of case series. However, there is no universal consensus on alternative approaches for GLP diagnosis in patients with negative standard endoscopic biopsy results.…”

Endoscopic Ultrasound-guided Fine Needle Aspiration for the Diagnosis of Duodenal Stenosis Due to Urothelial Carcinoma

“…The safety and outcomes of EUS-FNA have previously been analyzed (20)(21)(22), and its methods have been well established for sampling unexplained thickening of the esophagogastric wall and the diagnosis of linitis plastica in cases with negative endoscopic biopsy findings (23)(24)(25)(26)(27). Among 10 patients with unexplained thickening of the esophagogastric wall, five were diagnosed with carcinoma (esophageal carcinoma, n=2; gastric carcinoma, n=3) with-out complications using EUS-FNA (25).…”

Endoscopic ultrasound-guided fine-needle biopsy in patients with unexplained diffuse gastrointestinal wall thickening

“…"bite on bite" biopsy technique with jumbo forceps, mucosal resection and submucosal dissection techniques [4][5][6][7]. However, the improved diagnostic profitability is frequently achieved at the expense of an increased risk of bleeding and perforation.…”