Facing the challenge of managing linitis plastica--review of the literature

Linitis Plastica (LP) denotes a diffuse, intra-murally infiltrating, anaplastic carcinoma in a hollow structure resulting in a shrunken organ with thickened walls. The neoplasm is encountered in every segment of gastrointestinal tract with the gastric localization being the most frequent and simultaneous or successive affection of different digestive sites rarely reported. Symptoms often associated with LP of the stomach include pain and lump in the epigastrium, weight loss, anorexia, dysphagia, nausea and vomiting. Diagnosis of LP-type adenocarcinomas of the stomach has traditionally been achieved by brush cytology and mucosal biopsy. Nevertheless, these techniques may yield false negative results due to potential submucosal location of the lesion. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) contributes to the detection of abundant, independent malignant cells indicative of an anaplastic neoplasm. The characteristic histopathological feature of this entity is cellular spread to the submucosa and stroma with minimal mucosal alterations accompanied by an excessive desmoplastic reaction. Despite recent research on alternative therapies, surgical resection appears the only potentially curative approach. The aim of this review was to evaluate the results of current diagnostic modalities and surgical interventions for LP with special reference to the extent of its histological dissemination and to present the recent literature in order to provide an update on the contemporary concepts of therapeutic management of the disease.