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


OBJECTIVE
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).


METHODS
A case series.


METHODS
A single tertiary-referral center.


METHODS
Patients undergoing lower GI (LGI) EUS from July 1, 2005, to October 31, 2007.


METHODS
EUS-FNA and/or TCB.


METHODS
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).


CONCLUSIONS
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.
Gleeson
Ferga C
FC
Division of Gastroenterology and Hepatology, Department of Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Clain
Jonathan E
JE
Rajan
Elizabeth
E
Topazian
Mark D
MD
Wang
Kenneth K
KK
Wiersema
Maurits J
MJ
Zhang
Lizhi
L
Levy
Michael J
MJ
D000368:Aged; D001706:Biopsy / Q000379:methods; D044963:Biopsy, Fine-Needle / Q000379:methods*; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008039:Linitis Plastica / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014741:Video Recording