Secondary linitis plastica of the rectum: EUS features and tissue diagnosis (with video)

BackgroundLuminal metastases to the GI tract may be seen at the time of the primary diagnosis or may represent evidence of a distant recurrence.ObjectivesTo determine the prevalence of rectal-wall metastases in patients undergoing an EUS and to describe the EUS features and yield of EUS-guided FNA (EUS-FNA) and Trucut biopsy (TCB).DesignA case series.SettingA single tertiary-referral center.PatientsPatients undergoing lower GI (LGI) EUS from July 1, 2005, to October 31, 2007.InterventionEUS-FNA and/or TCB.Main Outcome MeasurementsEUS features and cytologic and/or histologic confirmation of secondary rectal linitis plastica.ResultsOver the 28-month period, an LGI-EUS was performed in 598 patients with presumed primary rectal cancer, of whom 6 (1%) were diagnosed with rectal-wall metastases. The EUS features were that of diffuse, circumferential, hypoechoic wall-thickening that mimics that of linitis plastica, breaching the muscularis propria in all cases. EUS-FNA and/or TCB of the rectal wall or perirectal lymph node established a diagnosis in all cases. The primary cancers originated from the bladder (n = 3), breast (n = 1), stomach (n = 1), and a right forearm cutaneous melanoma (n = 1). The time interval from the initial primary cancer diagnosis to that of GI-tract rectal metastasis ranged from 0 days (simultaneous diagnoses) to 119 months (mean ± SD 49 ± 43 months).LimitationsAlthough firm EUS criteria of rectal-wall metastases cannot be established based on 6 patients alone, certain features may prove useful for the diagnosis in the clinical practice.ConclusionsEUS-FNA and/or TCB can confirm the diagnosis of secondary linitis plastica of the rectum.