P4254 - A Case of Rare Metastatic Spread of Ductal Carcinoma as Linitis Plastica

Mark P. Michael, MD¹, Madeline Cleary, DO², Joo Hye Park, MD², Domenico Viterbo, MD², Seth Richter, MD^2
1Albany Medical Centre, Albany, NY; ²Albany Medical Center, Albany, NY

Introduction: Breast cancer most frequently spreads to lung, liver and bone, rarely metastasizing to the stomach. Of the two types of breast adenocarcinoma, lobular carcinoma (LC) is known to metastasize to various tissues throughout the body (1). The vast majority of studies reports ductal carcinoma (DC) in the stomach as discrete nodularity whereas LC commonly invades in a diffuse pattern called linitis plastica (LP)(1). To the best of our knowledge, very few cases have reported contrary (2-4). LP is also referred to as signet cell carcinoma or “leather bottle stomach” with diffuse infiltration to the submucosa and muscularis propria. Endoscopically, LP presents as hypertrophic gastric folds that are firm, rubbery and difficult to biopsy. We present a case of a patient with DC found to have diffuse gastric metastasis with histology positive for DC. This case describes a very rare metastatic spread of DC in the form of LP, which is contrary to common knowledge.

Case Description/Methods: A 65 year old female presented to the hospital with complaints of intractable nausea and vomiting. The patient had a past medical history of DC with metastasis to lungs, liver and bone. She underwent CT imaging notable for new diffuse thickening of gastric mucosa. Gastroenterology was consulted for EGD and gastrostomy tube placement. EGD was performed and LP was noted on visual examination. Enteric tube placement was deferred and biopsies were taken. Pathology was notable for metastatic adenocarcinoma (ER/PR-, GATA-3+, E-cadherin +) and the patient was diagnosed with diffuse gastric metastasis of DC. This diagnosis was felt to be a contraindication for PEG placement as the gastric wall would not heal well or accommodate use. Upon hospitalization fourteen months later the patient was on fifth line chemotherapy. Her clinical status continued to worsen with persistent nausea and poor oral intake and she was eventually discharged on home hospice.

Discussion: This case discusses a metastatic spread of DC that has only been reported in very few case reports. This patient was medically managed and was still on chemotherapy fourteen months after diagnosis of LP, which exceeds estimated prognosis of 3.6-8 months without resection.(5,6) This case highlights that medicine is an ever-growing field with new information challenging commonly held concepts, the importance of appropriate biopsies for histological analysis and the need for careful approach to feeding tube placement to ensure the benefits outweigh the risks in our patients.



Disclosures:


Mark P. Michael, MD¹, Madeline Cleary, DO², Joo Hye Park, MD², Domenico Viterbo, MD², Seth Richter, MD². P4254 - A Case of Rare Metastatic Spread of Ductal Carcinoma as Linitis Plastica, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.