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Secondary rectal linitis plastica as first manifestation of urinary bladder carcinoma.

Katsinelos P, Papaziogas B, Chatzimavroudis G, Katsinelos T, Dimou E, Atmatzidis S, Beltsis A, Terzoudis S, Kamperis E, Lazaraki G - Ann Gastroenterol (2012)

Bottom Line: We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation.Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa.He underwent rectal extirpation with total cystectomy and lymph nodes dissection.

View Article: PubMed Central - PubMed

Affiliation: Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki).

ABSTRACT
Secondary rectal linitis plastica is a very rare malignancy with poor prognosis. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and negative biopsies in most cases owing to the fact that the mucosa is frequently unaffected. We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation. Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa. Multiple biopsies and fine-needle aspiration were negative for malignancy. Abdominal MRI and transrectal ultrasonography showed findings compatible with rectal linitis plastica. He underwent rectal extirpation with total cystectomy and lymph nodes dissection. Histology demonstrated secondary rectal linitis plastica due to a poorly differentiated urinary bladder carcinoma. We emphasize the endoscopic and endosonographic features and the difficulty to establish a preoperative diagnosis of secondary rectal linitis plastica.

No MeSH data available.


Related in: MedlinePlus

Transrectal ultrasonography showing marked thickening of the rectal wall with expansion of the submucosa
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Figure 2: Transrectal ultrasonography showing marked thickening of the rectal wall with expansion of the submucosa

Mentions: A 68-year-old man presented to the Department of Endoscopy with a six-month history of anal outlet obstruction, constipation and tenesmus. The patient had no relevant past medical history. Digital examination revealed a circumferential rectal narrowing with a firm, mass-like area, palpable all around the rectal wall and extending to a few centimeters of the anal margin. Laboratory tests, including urinalysis, were unremarkable. Subsequent endoscopy demonstrated a narrow distal rectum, with the overlying mucosa being indurated, non-ulcerated, with a cobblestone appearance (Fig. 1). Several biopsies and fine-needle aspiration were taken, but none was conclusive for diagnosis. T2-weighted MRI showed a double-layered thickening of the rectal wall with an inner iso-intense circumferential thickening of the submucosa and outer hypo-intense circumferential thickening of the muscular rectal wall, as well as a thickened bladder wall. Transrectal ultrasonography showed circumferential infiltration of the submucosa, whereas the other layers were normal (Fig. 2); an image compatible with “linitis plastica”. The patient underwent rectal extirpation and total cystectomy with lymph node dissection. Macroscopic examination of a sagittal section of resected rectum demonstrated an expanded submucosal layer due to infiltration with cancer cells, with intact mucosa and muscular layer (Fig. 3). Histological examination of the resected bladder showed a grade III papillary transitional cell carcinoma. In the rectum clusters of tumor cells of a poorly differentiated adenocarcinoma were observed. Immunostaining was positive for both CK7 and CK20; PSA was negative. Combining the cytokeratine profile histology and transrectal ultrasonography findings, the diagnosis of a primary urinary bladder tumor with hematogenous spread to rectal submucosal layer was established.


Secondary rectal linitis plastica as first manifestation of urinary bladder carcinoma.

Katsinelos P, Papaziogas B, Chatzimavroudis G, Katsinelos T, Dimou E, Atmatzidis S, Beltsis A, Terzoudis S, Kamperis E, Lazaraki G - Ann Gastroenterol (2012)

Transrectal ultrasonography showing marked thickening of the rectal wall with expansion of the submucosa
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959401&req=5

Figure 2: Transrectal ultrasonography showing marked thickening of the rectal wall with expansion of the submucosa
Mentions: A 68-year-old man presented to the Department of Endoscopy with a six-month history of anal outlet obstruction, constipation and tenesmus. The patient had no relevant past medical history. Digital examination revealed a circumferential rectal narrowing with a firm, mass-like area, palpable all around the rectal wall and extending to a few centimeters of the anal margin. Laboratory tests, including urinalysis, were unremarkable. Subsequent endoscopy demonstrated a narrow distal rectum, with the overlying mucosa being indurated, non-ulcerated, with a cobblestone appearance (Fig. 1). Several biopsies and fine-needle aspiration were taken, but none was conclusive for diagnosis. T2-weighted MRI showed a double-layered thickening of the rectal wall with an inner iso-intense circumferential thickening of the submucosa and outer hypo-intense circumferential thickening of the muscular rectal wall, as well as a thickened bladder wall. Transrectal ultrasonography showed circumferential infiltration of the submucosa, whereas the other layers were normal (Fig. 2); an image compatible with “linitis plastica”. The patient underwent rectal extirpation and total cystectomy with lymph node dissection. Macroscopic examination of a sagittal section of resected rectum demonstrated an expanded submucosal layer due to infiltration with cancer cells, with intact mucosa and muscular layer (Fig. 3). Histological examination of the resected bladder showed a grade III papillary transitional cell carcinoma. In the rectum clusters of tumor cells of a poorly differentiated adenocarcinoma were observed. Immunostaining was positive for both CK7 and CK20; PSA was negative. Combining the cytokeratine profile histology and transrectal ultrasonography findings, the diagnosis of a primary urinary bladder tumor with hematogenous spread to rectal submucosal layer was established.

Bottom Line: We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation.Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa.He underwent rectal extirpation with total cystectomy and lymph nodes dissection.

View Article: PubMed Central - PubMed

Affiliation: Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki).

ABSTRACT
Secondary rectal linitis plastica is a very rare malignancy with poor prognosis. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and negative biopsies in most cases owing to the fact that the mucosa is frequently unaffected. We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation. Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa. Multiple biopsies and fine-needle aspiration were negative for malignancy. Abdominal MRI and transrectal ultrasonography showed findings compatible with rectal linitis plastica. He underwent rectal extirpation with total cystectomy and lymph nodes dissection. Histology demonstrated secondary rectal linitis plastica due to a poorly differentiated urinary bladder carcinoma. We emphasize the endoscopic and endosonographic features and the difficulty to establish a preoperative diagnosis of secondary rectal linitis plastica.

No MeSH data available.


Related in: MedlinePlus