title: Submucosal Endoscopic Sampling for Indefinite Gastric Linitis Plastica Infiltrating into the Submucosal Layer.
abstract: The diagnosis of diffuse-type gastric cancer, named linitis plastica (LP), is difficult because of its infiltration into the submucosa. Conventional endoscopic biopsy sampling may show false-negative results because the superficial mucosa is often normal. These macroscopic features do not often permit the distinction between benign and malignant lesions, and sampling methods have some limitations. Accordingly, a secure sampling method is required in order to increase the diagnostic yield. We have developed a submucosal tunneling technique for sampling submucosal tumors, which can visualize tumor surfaces and obtain tissue samples under direct vision. We report a rare case of indefinite gastric LP that could be diagnosed by this method. As multiple biopsies and endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) did not help us histologically diagnose the lesion, our new method of submucosal endoscopy which has advantages of visualizing tumor surfaces and obtaining tissue samples under direct vision in the submucosa was introduced. Histological examination of all acquired samples confirmed the presence of a poorly differentiated adenocarcinoma. The present case demonstrates that this method is a reasonable option for indefinite LP with features inflating into submucosa, providing an update on the contemporary concepts.
authors.affiliation: Department of Gastroenterology and Neurology; Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Chiyo
authors.affiliation: Department of Gastroenterology and Neurology; Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan. kobara@med.kagawa-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Department of Gastroenterology and Neurology; Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Katsuki
authors.affiliation: Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Reiji
authors.initials: R
authors.lastname: Haba
authors.affiliation: Department of Gastroenterology and Neurology; Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000368:Aged; D001706:Biopsy; D002454:Cell Differentiation; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008039:Linitis Plastica / Q000000981:diagnostic imaging / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011859:Radiography; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*