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CT Features of Metastatic Linitis Plastica to the Rectum in Patients with Peritoneal Carcinomatosis

Hyun Kwon Ha1, Keum Rahn Jee1, Eunsil Yu2, Chang Sik Yu3, Sung Eun Rha1, In Jae Lee1, Hee Ja Yun1, Jin Cheon Kim3, Kun Choon Park3 and Yong Ho Auh1

1 Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap Dong Songpa Ku, Seoul, 138-040, Korea.
2 Department of Pathology, Asan Medical Center, Seoul, 138-040 Korea.
3 Department of Surgery, Asan Medical Center, Seoul, 138-040 Korea.



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  		Fig. 1A. —55-year-old man with metastatic linitis plastica of rectum. Patient underwent subtotal gastrectomy for gastric cancer (poorly differentiated type) 43 months previously and then underwent palliative sigmoid loop colostomy. Contrast-enhanced CT scan shows concentric rectal wall thickening (arrowheads) with target sign. Images revealed 3-cm mass (not shown) in rectovesical pouch. Bladder wall is thickened (arrows). Proctoscopy and cystoscopy confirmed tumor infiltration to rectum and bladder.

 


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  		Fig. 1B. —55-year-old man with metastatic linitis plastica of rectum. Patient underwent subtotal gastrectomy for gastric cancer (poorly differentiated type) 43 months previously and then underwent palliative sigmoid loop colostomy. Contrast-enhanced CT scan 4 cm caudad to A shows downward extension of tumor invasion (arrows) to lower rectum and level of anal verge. Note minimal infiltration (arrowheads) in perirectal fat plane.

 


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  		Fig. 2. —65-year-old woman with metastatic linitis plastica of rectum and Krukenberg's tumor of ovary. Patient underwent total gastrectomy for gastric cancer (signet ring cell type). Contrast-enhanced CT scan shows concentric thickening (arrows) of rectal wall with target sign. Images reveal irregular uterine (U) surface. Note left ovarian mass (K), ascites (asterisk), and focal thickening of peritoneum (arrowhead).

 


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  		Fig. 3A. —61-year-old woman with metastatic linitis plastica of rectum. Patient underwent total gastrectomy for gastric cancer (poorly differentiated type) 45 months previously and then underwent palliative sigmoid loop colostomy for rectal obstruction. Contrast-enhanced CT scan shows concentric thickening of rectal wall without target sign. Note ill-defined mass (arrow) in cul-de-sac.

 


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  		Fig. 3B. —61-year-old woman with metastatic linitis plastica of rectum. Patient underwent total gastrectomy for gastric cancer (poorly differentiated type) 45 months previously and then underwent palliative sigmoid loop colostomy for rectal obstruction. Double-contrast barium enema shows narrowing of rectum and thickened mucosal folds with irregular contour (arrows). Note concentric luminal narrowing (asterisk) in transverse colon caused by peritoneal tumor seeding.

 


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  		Fig. 3C. —61-year-old woman with metastatic linitis plastica of rectum. Patient underwent total gastrectomy for gastric cancer (poorly differentiated type) 45 months previously and then underwent palliative sigmoid loop colostomy for rectal obstruction. Photomicrograph shows diffuse involvement of entire wall by poorly differentiated adenocarcinoma. Mucosa is eroded (arrowheads) and submucosa (SM) and subserosa (SS) are significantly thickened because of tumor infiltration and reactive fibrosis. Compared with healthy corresponding layer (arrows), proper muscularis (PM) is considerably thickened because of hypertrophic changes of muscle fiber and tumor infiltration. (H and E, x5)

 


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  		Fig. 4. —59-year-old woman with metastatic linitis plastica to rectum. Patient underwent total hysterectomy with bilateral salpingo-oophorectomy for cervical cancer (squamous cell type) 21 months previously and then underwent palliative transverse colon colostomy. Contrast-enhanced CT scan shows heterogeneous rectal wall thickening with recurrent pelvic mass (black arrows) in area of vaginal stump. Posterior bladder wall is thickened because of tumor invasion. Note minimal perirectal lymphadenopathy (arrowheads), fluid collection in presacral space, and thickening of both ureteral walls (white arrows). Cystoscopic examination confirmed tumor invasion to bladder.

 

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