Yara Dababneh, MD1, Diana Jomaa-Rteil, MD2, Jonathan A. Montrose, DO2, Palak Patel-Rodrigues, DO1, Mark Obri, MD2, Muhammad Salman Faisal, MD1, Jason JN. Schairer, MD2, Sumit Singla, MD2, Mazen Elatrache, MD2, Sumair Ahmad, MD2 1Henry Ford Hospital, Detroit, MI; 2Henry Ford Health, Detroit, MI Introduction: Gastric Linitis Plastica or “Leather Bottle” is a term used to describe the gross appearance of the stomach in the setting of extensive infiltration of cancer cells.
Case Description/
Methods: 78-year-old female presented with a significant history of worsening dysphagia to solids and liquids and 30 lbs. weight loss over the past 3 months. She was evaluated by our gastroenterology team and underwent an upper endoscopy which was normal and didn’t show any concerning features. Biopsies were done to rule out Eosinophilic Esophagitis (EoE) and were negative. Computed tomography (CT) of the abdomen and pelvis revealed Nonspecific thickening of the gastroesophageal junction with soft tissue extending into the retroperitoneum involving the left adrenal gland and left renal pedicle with circumferential wall thickening of the proximal and mid stomach, in addition to prominent retroperitoneal lymphadenopathy. Our Advanced Gastroenterology team were involved and planned for Endoscopic Ultrasound (EUS) which showed reduced distensibility of the stomach and this was apparent mainly on retroflexion as it was extremely challenging, with thickening of gastric folds in the body region (Figure 1) highly concerning for Linitis Plastica, biopsies were performed. EUS revealed severe diffuse thickening and distortion of gastric walls (Figure 2) with few suspicious hypoechoic lymph nodes. Fine Needle Biopsies (FNB) were performed. Stomach biopsies were positive for Helicobacter Pylori gastritis, Biopsies from the gastric wall and lymph nodes were both positive for metastatic poorly differentiated adenocarcinoma. The patient followed up with oncology with a plan to start chemotherapy; she then developed an acute ischemic stroke and ultimately passed away. Discussion: Dysphagia and weight loss are highly concerning for possible malignancy. The association between dysphagia and Linitis Plastica is still unclear, and very rarely reported for dysphagia to be the presenting symptom. Upper endoscopy is the main diagnostic approach with detailed examination that could reveal features of decreased distensibility and biopsies positive for malignant cells. It is important to be vigilant during examination of the stomach as it can be easily missed as well as maintaining a high index of clinical suspicion to pursue further diagnostic images or EUS.
Figure: Figure 1. Diffuse thickening of gastric folds in the body region.
Figure: Figure 2. Thickening of gastric wall on EUS up to 21mm.
Disclosures: Yara Dababneh indicated no relevant financial relationships. Diana Jomaa-Rteil indicated no relevant financial relationships. Jonathan Montrose indicated no relevant financial relationships. Palak Patel-Rodrigues indicated no relevant financial relationships. Mark Obri indicated no relevant financial relationships. Muhammad Salman Faisal indicated no relevant financial relationships. Jason Schairer indicated no relevant financial relationships. Sumit Singla: Boston Scientific. – Consultant. Mazen Elatrache indicated no relevant financial relationships. Sumair Ahmad indicated no relevant financial relationships.
Yara Dababneh, MD1, Diana Jomaa-Rteil, MD2, Jonathan A. Montrose, DO2, Palak Patel-Rodrigues, DO1, Mark Obri, MD2, Muhammad Salman Faisal, MD1, Jason JN. Schairer, MD2, Sumit Singla, MD2, Mazen Elatrache, MD2, Sumair Ahmad, MD2. P6362 - Beneath the Surface of a “Leather Bottle Stomach”: Atypical Fatal Presentation of Linitis Plastica and Progressive Esophageal Dysphagia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
