Plastic linitis C16.9

The term "linitis plastica" was first described in 1779 by the French physician Joseph Lieutaud. A detailed description and the coining of the name were provided in 1859 by the English physician William Brinton. He considered the lesion to be benign. It was not until 1953 that Arthur Stout demonstrated its malignancy (El-Nakeep 2023).

Although linitis plastica has been known for centuries, there is still no standardized definition for this clinical condition (Agnes 2017).

Linitis plastica (LP) is defined as the loss of elasticity in hollow organs, particularly the stomach (Kasper 2015), caused by a circular infiltrative lesion (Rudralingam 2003). This can occur, for example, in the context of gastric carcinoma of the “diffuse type” according to the Lauren classification (Herold 2025).

Between 7% and 10% of patients with primary gastric cancer have linitis plastica (El-Nakeep 2023).

The etiology of LP has not yet been fully elucidated. It can occur in the context of the following diseases:

• Diffusely infiltrating gastric carcinoma
• As part of tuberculosis
• In cases of syphilitic infiltration of the stomach associated with syphilis
• GIST (Riemann 2008)
• Gastric lymphoma (Schmoll 2006)
• Gastric diverticulosis (Pantel 2005)

In LP, for example, gastric carcinoma leads to diffuse proliferation of connective tissue. This results in thickening and stiffness of the stomach wall, causing narrowing of the stomach (Vardali 2016). As a result, the stomach loses its elasticity (Beers 2007).

LP is found primarily in the stomach, but it is also present in other hollow organs, such as the colon or rectum (Rudralingam 2003).

Until it reaches an advanced stage, linitis plastica is usually asymptomatic. Patients who do experience symptoms most commonly report dyspepsia (in 55%), vomiting (in 33%), and dysphagia (in 33%). These symptoms are generally caused by a severe reduction in the stomach’s distensibility (El-Nakeep 2023).

• Endoscopic Examination

The diagnosis can be made through an endoscopic examination with biopsy sampling (Vardali 2016). During the procedure, every visible mucosal lesion and all light-colored or white areas should be biopsied (Guideline 2025). However, the biopsy forceps often slip off the infiltrated wall (Beyrouti 2007).

• Computed tomography:

This reveals a circular thickening of the organ wall or a concentric ring pattern (Rudralingam 2003).

• Immunohistochemistry:

Since the mucosa is often unaffected, endoscopy may yield false-negative results. Immunohistochemistry is therefore always recommended (Sanchez 2025).

Histologically, in the area affected by linitis plastica, the following are found:

• Signet-ring cells
• Glandular proliferation of autonomic cells
• Infiltration of all layers except the mucosa (Vardali 2016)

• Atrophic gastritis with reduced gastric distensibility
• Hypertrophic chronic Helicobacter pylori gastritis
• Corrosive gastritis
• Following partial gastrectomy (El-Nakeep 2023)

Malnutrition, ranging up to severe cachexia (El-Nakeep 2023)

In cases of linitis plastica caused by gastric carcinoma, treatment includes a total gastrectomy, chemotherapy (Vardali 2016), and, occasionally, radiation therapy (El-Nakeep 2023). However, at the time of diagnosis, most patients already have metastases, so only a palliative treatment approach is possible (El-Nakeep 2023).

In cases associated with syphilis, linitis plastica may resolve with appropriate treatment of the syphilis (Schlesinger 1926).

The prognosis for patients with gastric cancer associated with linitis plastica is considered poor, particularly for those who undergo primary surgery. The use of preoperative chemotherapy, chemoradiotherapy, and subsequent gastrectomy has proven to be important in selected patients (Ikoma 2019).

1. Agnes A, Estrella J S, Badgwell B (2017) The significance of a nineteenth-century definition in the era of genomics: linitis plastica. World J Surg Onc 15, 123 https://doi.org/10.1186/s12957-017-1187-3
2. Beyrouti I, Beyrouti R, Ben Amar M, Frikha F, Abis M, Ben Salah K, Boujelben S (2007) Linitis plastica. Presse Médicale 36 (12) 1782–1786
3. Beers M. H. et al. (2007) The MSD Manual. Elsevier Urban and Fischer Verlag 206
4. Blackham A. U., Swords D. S., Levine E. A., Fino N. F., Squires M. H., Poultsides G., Fields R. C., Bloomston M., Weber S. M., Pawlik T. M., Jin L. X., Spolverato G., Schmidt C., Worhunsky D., Cho C. S., Maithel S. K., Votanopoulos K. I. (2016) Is Linitis Plastica a Contraindication for Surgical Resection: A Multi-Institution Study of the U.S. Gastric Cancer Collaborative. *Annals of Surgical Oncology* 23, 1203–1211
5. El Nakeep S, Kasi A (2023) Linitis Plastica SatPearls Treasure Island. https://pubmed.ncbi.nlm.nih.gov/33085441/
6. Herold G et al. (2025) Internal Medicine. Herold Verlag 449
7. Ikoma N, Agnes A, Chen H C, Wang X, Blum M M, Das P, Minsky B, Estrella J S, Mansfield P, Ajani J A, Badgwell B D (2019) Linitis Plastica: a Distinct Type of Gastric Cancer. Gastrointest Surg 24 1018–1025
8. Kasper D. L., Fauci A. S., Hauser S. L., Longo D. L., Jameson J. L., Loscalzo J., et al. (2015) Harrison’s Principles of Internal Medicine. McGraw-Hill Education 534
9. Pantel S D, Semeraro D, Hall R I (2005) Linitis Plastica due to gastric diverticulosis. J R Soc Med. 98 (9) 416–417
10. Riemann J F (2008) Pathological Anatomy: Intestine, Stomach, and Duodenum. DOI: 10.1055/b-0034-79877
11. Rudralingam V, Dobson M J, Pitt M, Stewart D J, Hearn A, Susnerwala S (2003) MR Imaging of Linitis Plastica of the Rectum. Ameri J o Roentg. 181 (2) https://ajronline.org/doi/full/10.2214/ajr.181.2.1810428
12. Schlesinger H (1926) Syphilis and Internal Medicine. Springer Verlag Wien GmbH 154
13. Schmoll H J, Höffken K, Possinger K. (2006) Compendium of Medical Oncology: Standards in Diagnosis and Therapy. Springer Medizin Verlag, Heidelberg, 475
14. S3 Guideline (2025) Diagnosis and Treatment of Adenocarcinomas of the Stomach and the Esophagogastric Junction. AWMF Registration Number: 032-009OL
15. Vardarli M. C. et al. (2016) Linitis plastica. DocCheck Flexikon https://flexikon.doccheck.com/de/Linitis_plastica