Gastrointestinal: Secondary gastric linitis plastica: A peritoneal recurrence of breast cancer

A 64-year-old woman who underwent surgical treatment for breast cancer 8 years ago was referred to our institute for the evaluation of lower extremity edema. Laboratory assessment showed a hemoglobin level of 8.6 g/dL. Serum albumin and tumor marker levels (carcinoembryonic antigen and carbohydrate antigen 19-9) were within the normal range. Contrast-enhanced computed tomography revealed bilateral pleural effusion, ascites, left hydronephrosis, and multiple nodules in the peritoneum. Esophagogastroduodenoscopy showed reddish and thickened gastric folds with poor gastric wall distension (Fig. 1a). A barium study revealed wall stiffness at the gastric body (Fig. 1b). These findings suggested linitis plastica of the stomach. Neither histological examination of biopsy specimens of the gastric body nor cytological analysis of the pleural effusion and ascites showed signs of malignancy. She underwent laparoscopic partial gastrectomy to confirm a diagnosis. Histopathological analysis demonstrated that the cancer cells were located beyond the submucosa (Fig. 2). Immunohistochemical staining was consistent with that of the previously resected lobular carcinoma of the breast. On the basis of these findings, we diagnosed her with peritoneal recurrence of breast cancer. She was started chemotherapy with an aromatase inhibitor. Thereafter, her pleural effusion, ascites, and lower extremity edema improved. Peritoneal breast cancer metastasis, sometimes presenting as linitis plastica of the stomach, mimics primary gastric cancer. It may be difficult to diagnose by endoscopic biopsy. In the present case, surgical biopsy was useful for the diagnosis.