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Video Endoscopy Sequence 1 of 15.
Scirrhous Gastric Carcinoma (Linitis Plastica).
An 80 year-old female with satiety and weight loss.
The image and the video clip shows diffuse infiltrating
adenocarcinoma with signet-ring cells.
Medline.
For further endoscopic information, download the video clip
by clicking on the endoscopic image. Wait to be
downloaded complete then Press Alt and Enter for full
screen (Windows Media), Real Player: Ctrl and 3.
All endoscopic images shown in this Atlas contain
video clips. We recommend seeing the video clips in full
screen mode.
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Video Endoscopy Sequence 2 of 15.
Linitis Plastica.
The posterior wall of the stomach is infiltrating from the
antrum to the fundus.
The term ”Linitis Plastica” refers to a scirrhous form of
carcinoma that spreads predominantly in the submucosa,
eliciting a marked desmoplastic response in the gastric
wall.
They classically arise in the antrum and infiltrate towards
the fundus.
Medline.
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Video Endoscopy Sequence 3 of 15.
Indigo Carmine Stain.
The diffuse type of gastric cancer often manifests itself as
a linitis plastica. It is harder to diagnose than the intestinal
type, particularly in the earlier stages. Thus, although
diagnostic techniques have improved, some gastric cancers
are still missed on the initial investigation.
Medline.
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Video Endoscopy Sequence 4 of 15.
This image shows the contrast between normal folds and
infiltrating adenocarcinoma.
Findings suggest that the difficulty of detection and the
rapid growth of this tumor may explain why it is seldom
detected at an early stage and has a very poor prognosis.
Medline.
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Video Endoscopy Sequence 5 of 15.
High Magnification Endoscopy.
You can observe a close up of the malign nodules.
Tumor mass of the stomach from patients with scirrhous.
carcinoma was analyzed biochemically and
immunohistochemically to elucidate whether or not
infiltrating carcinoma cells are directly responsible for
overproductions of collagen in the lesion. Collagen content
per unit transverse section of the tumor was two to four
times higher than the normal. Of particular interest was
that the contents of hyaluronic acid and chondroitin sulfate
were five to ten times higher than the normal, suggesting
that cells in the lesion of the tumor are in an actively
proliferating stage.
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Video Endoscopy Sequence 6 of 15.
Chromoendoscopy using methylene blue.
Chromoendoscopy involves the topical application of stains
or dyes to improve mucosal visualization during endoscopy.
stain.
Although collagen synthesis is increased in gastric
carcinoma tissues irrespective of the amount of the stroma,
it is suggested that decreased collagenase activities and
increased expression of TIMP-1 would result in collagen
deposition in scirrhous gastric carcinoma tissue and the
response might actually benefit the invasion of tumor cells.
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Video Endoscopy Sequence 7 of 15.
Lugol´s Stain.
Chromoendoscopy involves the application of vital dyes
that enhance the visibility of abnormal tissues.
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Video Endoscopy Sequence 8 of 15.
Endosonography.
The endosonography can clearly visualize the architecture
of the stomach. This make it possible to find destruction
of the gastric layers.
In infiltrating gastric cancer there are typical
endosonographic pictures. The layers are visualized, but
there are larger and with irregular contour.
Especially the submucosa and muscularis are concentrically
enlarged.
Download the video clips.
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Video Endoscopy Sequence 9 of 15.
Endoscopic Ultrasonography.
Characteristic features of scirrhous carcinoma included an
irregular hypoechoic enlargement of the third (submucosa)
and fourth (muscularis propria) layers.
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Video Endoscopy Sequence 10 of 15.
The diagnosis of diffuse type gastric carcinoma is very
difficult. The delay of diagnosis is often due to
false-negative endoscopic and histologic evaluation. The
architecture of the stomach can be clearly visualized by
endosonography. Therefore, already minor destructions of
the gastric layers can be found. The endosonographic
picture includes the presence of the layers, which are larger
and of irregular contour. In infiltrating gastric cancer
typically the submucosal layer and the muscularis are
concentrically enlarged and appear folded.
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Video Endoscopy Sequence 11 of 15.
Note the difuse mural thickening of the gastric camera due to a infiltrating tumor.
Scirrhous carcinomas showed both a thick outer layer and a
thick inner layer, whereas non-scirrhous carcinomas did not
have appearance. This classification can serve as a
guideline for predicting scirrhous carcinoma on the basis of
CT findings.
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Video Endoscopy Sequence 12 of 15.
Note the liver metastasis.
CT is an important complimentary imaging technique to
detect scirrhous carcinoma. The sensitivity of detection
depends on the size of the lesion and the quality of the
examination. CT has limitations in staging early lesions but
shows a high sensitivity (89%) in detecting avanced
carcinomas.
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Video Endoscopy Sequence 13 of 15.
More images of the cat scan.
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Video Endoscopy Sequence 14 of 15.
"leather-bottle stomach".
The radiological study of the patient.
While the radiological features are not diagnostic, they are, in
many cases, suggestive of this entity.
Medline.
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Video Endoscopy Sequence 15 of 15.
Cells of the "Signet Ring" type.
After multiple histologic sections it was found between the
muscularis mucosa a small group of epithelial cells of the
"Signet Ring" type.
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Video Endoscopy Sequence 1 of 15.
Scirrhous Gastric Carcinoma (Linitis Plastica).
This 16 year-old female, two months previously initiates with abdominal pain, abdominal discomfort, nauseas, vomiting, early diminished appetite, satiety and weight loss.
One year and a half we found that her grandmother had a gastric carcinoma.
Perhaps this patient is one of youngest one that has
suffered from gastric cancer in medical Literature.
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Video Endoscopy Sequence 2 of 15.
In this video endoscopic sequence shows extensive infiltration of this neoplasia from the gastric antrum to the fundus and gastric cardias.
Gastric cancer is uncommon in the young. Occasional reports are found in the literature.
Anaplastic infiltrative adenocarcinoma of the linitis plastica morphologic type is rare in adolescents.
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Video Endoscopy Sequence 3 of 15.
Scirrhous tumors metastasize early, grow quickly, and spread over the peritoneum. Prognosis is poor. Tumor cells are in the submucosa and are separated by abundant connective tissue. It can be difficult to diagnosis with UGI or endoscopy.
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Video Endoscopy Sequence 4 of 15.
Endoscopy is 95% to 98% sensitive in diagnosing gastric
cancer when performed along with biopsy. It has much
lower sensitivity in diagnosing linitis plastica because the
tumor is in the submucosa and the overlying mucosa is
normal. Scirrhous tumors are also difficult to diagnose
because tumor cells are spread within a dense fibrous
matrix and are far apart. Preoperative diagnosis is
important.
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Video Endoscopy Sequence 5 of 15.
Endoscopically found to show insufficient stretching of the
gastric wall, thickening and tortuosity of folds, uneven
gastric mucosa, redness and white coating, there may be
negative in gastric biopsy.
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Video Endoscopy Sequence 6 of 15.
Linitis plastica(scirrhous gastric carcinoma)is characterized by an abundant deposition of extracellular matrix components and has a very poor prognosis.Altered synthesis of extracellular matrix components as well as degradation by proteolytic enzymes contribute equally to the formation of the tumor stroma, which would affect various cell functions and in finally, determine the biologic behavior of the tumor.Although little is known about the underlying mechanisms and the significance of desmoplasia, overexpression of extracellular matrix components mainly by host cells, in the development of linitis plastica, the phenomenon has a similarity with pathological conditions such as fibrosis of the lungs and liver.Currently known stromal changes in linitis plastica, focusing on extracellular macromolecules, proteolytic enzymes, and growth factors modulating the process of physiological tissue remodeling.
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Video Endoscopy Sequence 7 of 15.
With difficulty it is performed the retroflexión maneuver
In the image and the video clip, it is observed the infiltration of the cardia and fundus.
Linitis plastica, a diffuse infiltrative gastric
adenocarcinoma which gives the stomach a shrunken
"leather bottle" appearance with extensive mucosal
erosion and a markedly thickened gastric wall. This type
of carcinoma has a very poor prognosis.
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Video Endoscopy Sequence 8 of 15.
16 year-old female with Scirrhous Gastric Carcinoma (Linitis Plastica).
This picture shows the abdomen with ascites.
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Video Endoscopy Sequence 9 of 15.
Lateral Image.
The word ascites is of Greek origin (askos) and means bag or sac. Ascites describes the condition of pathologic fluid accumulation within the abdominal cavity.
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Video Endoscopy Sequence 10 of 15.
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Video Endoscopy Sequence 11 of 15.
To download a high resolution and large image click here
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Video Endoscopy Sequence 12 of 15.
The walls of the stomach appeared thickened, and the
stomach distended poorly. Biopsies confirmed the
suspicion of diffusely infiltrating, poorly differentiated
adenocarcinoma with signet-ring cells.
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Video Endoscopy Sequence 13 of 15.
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Video Endoscopy Sequence 14 of 15.
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Video Endoscopy Sequence 15 of 15.
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Video Endoscopic Sequence 1 of 3.
Early Gastric Carcinoma with gastric carcinoma of the signet ring cell type (Plastic Linitis).
A 43-year old man with a lesion that can only seen in
retroflexed maneuver, because of the antrum wall showed
some rigidity due to an early gastric carcinoma Type III.
The image and video display some typical parameters of
criteria of a malign ulcer.
1. Fold tapering
2. Ulcer
3. Fusion of folds
4. Abrupt termination of fold
5. Discoloration
6. Depressed mucosal surface
7. Bulbous enlargement.
Diagnostic evaluation of patients with early gastric
cancer--a literature review.
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Video Endoscopic Sequence 2 of 3.
Relatively small size linitis plastica of the stomach
Linitis plastica (scirrhous gastric carcinoma) has a poor
prognosis due to delay in diagnosis. Pathological feature of
this tumor is diffuse fibrosis of the gastric wall. Detection
of small fibrotic lesion in the gastric wall would contribute
to early diagnosis of linitis plastica, since the primary
lesion usually lacks remarkable protrusion or ulceration.
Early Gastric Cancer, type III typical abrupt and irregular
termination of gastric folds at the ulcer margin.
Early Gastric Cancer is defined as limited to the mucosa
and or submucosa.
Metastasis to regional lymph nodes and even to distant
organs may already exist at this stage.
More than 90 per cent of gastric cancer patients complain
of one or several abdominal symptoms. The symptoms are
nonspecific disease entity and the patient should be
evaluated with an upper endoscopy mass screening should
be done in countries of a high incidence such as the
republic of El Salvador.
Medline.
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Video Endoscopic Sequence 3 of 3.
Patient delayed the surgery for more than 7 months. The
carcinoma was then found in an early phase. The
endoscopic image and video display this gastric
carcinoma after more than 7 months of the first
endoscopy. (This endoscopy was taken after 7 months of
the previous one see the previous video clips 1 of 3 and 2
of 3.) Patient underwent a subtotal gastrectomy, is free of
symptoms 5 years after.
See and click on the images below. Download the video.
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Early Gastric Carcinoma
Macroscopic details of the gastric ulcer of 1.3 cm. with the gastric folds directed to the ulcer’s borders.
Click on the images to image map.
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Transversal section shows the penetration level on
the submucosa.
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Histologic pattern of gastric carcinoma of the signet
ring cell type.
Click on the image to image map.
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 Linitis Plastica.
A 27 year-old man with weight loss more than 30
pounds, early satiety, apathy, anorexia and vomiting.
The walls of the stomach appeared thickened, the stomach
distended poorly.
Infiltrating adenocarcinoma of the diffuse type with
signet-ring cells was found.
biopsy proved to be a poorly differentiated adenocarcinoma
, signet ring cell type.
Gastric Cancer in young patient is more likely to be of
the diffuse type and associated with poorer prognosis.
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Linitis Plastica.
This 68 year-old male presented with initiates with
abdominal pain, abdominal discomfort, nauseas, vomiting,
early diminished appetite, satiety and weight loss.
Gastric Adenocarcinoma that has an erosive appearance.
The histopathologic study revealed signet ring cells.
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Hereditary diffuse gastric (stomach) cancer (HDGC).
Extensive Gastric Adenocarcinoma
A 39 year-old man, who was under medical control in a
national institution for more than 4 years because of
epigastric discomfort, but no upper endoscopy was
perform.
When he asked for help in our clinic he had already lost
a weight of 20 pounds.
We performed an upper endoscopy and an advanced
adenocarcinoma was found. It infiltrated the antrum,
body and the fundus along of the minor curvature.
We detected a gastric adenocarcinoma to his father
1991 at the antrum.
His father died 10 years later at age 85, but for a different
disease.
His mother died of gastric cancer many years ago.
We found two nephew had Advanced Gastric Carcinoma
recently. See the sequences below one case of them is not
published here because we have not found the video yet.
Several member of that family had die of breast cancer.
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